|
HC Z BIOLOX 36 FEM HO +0
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,397.36
|
|
|
HC Z BIOLOX 40 FEM HD +0
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,397.36
|
|
|
HC Z BIOLOX 40 FEM HD +0
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
|
HC Z BIOLOX 40 FEM HD +3.5
|
Facility
|
OP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,397.36
|
|
|
HC Z BIOLOX 40 FEM HD +3.5
|
Facility
|
IP
|
$7,491.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
|
HC Z BLADE 19X90X1.27
|
Facility
|
IP
|
$455.00
|
|
| Hospital Charge Code |
41605485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna All Commercial |
$392.67
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
|
|
HC Z BLADE 19X90X1.27
|
Facility
|
OP
|
$455.00
|
|
| Hospital Charge Code |
41605485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$384.02
|
| Rate for Payer: Aetna Medicare |
$145.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$261.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$284.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.16
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Centivo All Commercial |
$247.52
|
| Rate for Payer: Cigna All Commercial |
$392.67
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Humana Medicare |
$145.60
|
| Rate for Payer: Lucent All Commercial |
$247.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.45
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$386.75
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
| Rate for Payer: United Healthcare Medicare |
$145.60
|
|
|
HC Z BLADE HIP STEM REMOVAL
|
Facility
|
IP
|
$8,359.20
|
|
| Hospital Charge Code |
41608315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,269.40 |
| Max. Negotiated Rate |
$7,774.06 |
| Rate for Payer: Aetna Commercial |
$7,222.35
|
| Rate for Payer: Cash Price |
$5,015.52
|
| Rate for Payer: Cigna All Commercial |
$7,213.99
|
| Rate for Payer: CORVEL All Commercial |
$7,774.06
|
| Rate for Payer: Coventry All Commercial |
$7,356.10
|
| Rate for Payer: Encore All Commercial |
$7,694.64
|
| Rate for Payer: Frontpath All Commercial |
$7,690.46
|
| Rate for Payer: Humana ChoiceCare |
$7,219.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,523.28
|
| Rate for Payer: PHCS All Commercial |
$6,269.40
|
| Rate for Payer: PHP All Commercial |
$6,339.62
|
| Rate for Payer: Sagamore Health Network All Products |
$6,453.30
|
| Rate for Payer: Signature Care EPO |
$6,938.14
|
| Rate for Payer: Signature Care PPO |
$7,356.10
|
| Rate for Payer: United Healthcare Commercial |
$6,587.05
|
|
|
HC Z BLADE HIP STEM REMOVAL
|
Facility
|
OP
|
$8,359.20
|
|
| Hospital Charge Code |
41608315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$7,774.06 |
| Rate for Payer: Aetna Commercial |
$7,055.16
|
| Rate for Payer: Aetna Medicare |
$2,674.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,591.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,800.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,225.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,076.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,942.44
|
| Rate for Payer: Cash Price |
$5,015.52
|
| Rate for Payer: Cash Price |
$5,015.52
|
| Rate for Payer: Centivo All Commercial |
$4,547.40
|
| Rate for Payer: Cigna All Commercial |
$7,213.99
|
| Rate for Payer: CORVEL All Commercial |
$7,774.06
|
| Rate for Payer: Coventry All Commercial |
$7,356.10
|
| Rate for Payer: Encore All Commercial |
$7,694.64
|
| Rate for Payer: Frontpath All Commercial |
$7,690.46
|
| Rate for Payer: Humana ChoiceCare |
$7,219.84
|
| Rate for Payer: Humana Medicare |
$2,674.94
|
| Rate for Payer: Lucent All Commercial |
$4,547.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,523.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$6,269.40
|
| Rate for Payer: PHP All Commercial |
$6,339.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,260.09
|
| Rate for Payer: Sagamore Health Network All Products |
$6,453.30
|
| Rate for Payer: Signature Care EPO |
$6,938.14
|
| Rate for Payer: Signature Care PPO |
$7,356.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,105.32
|
| Rate for Payer: United Healthcare Commercial |
$6,587.05
|
| Rate for Payer: United Healthcare Medicare |
$2,674.94
|
|
|
HC Z BLADE RECIP 12.5X76X1.19L
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
41608295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna Commercial |
$336.76
|
| Rate for Payer: Aetna Medicare |
$127.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$229.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.45
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Centivo All Commercial |
$217.06
|
| Rate for Payer: Cigna All Commercial |
$344.34
|
| Rate for Payer: CORVEL All Commercial |
$371.07
|
| Rate for Payer: Coventry All Commercial |
$351.12
|
| Rate for Payer: Encore All Commercial |
$367.28
|
| Rate for Payer: Frontpath All Commercial |
$367.08
|
| Rate for Payer: Humana ChoiceCare |
$344.62
|
| Rate for Payer: Humana Medicare |
$127.68
|
| Rate for Payer: Lucent All Commercial |
$217.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$359.10
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$299.25
|
| Rate for Payer: PHP All Commercial |
$302.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.61
|
| Rate for Payer: Sagamore Health Network All Products |
$308.03
|
| Rate for Payer: Signature Care EPO |
$331.17
|
| Rate for Payer: Signature Care PPO |
$351.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$314.41
|
| Rate for Payer: United Healthcare Medicare |
$127.68
|
|
|
HC Z BLADE RECIP 12.5X76X1.19L
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
41608295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna Commercial |
$344.74
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna All Commercial |
$344.34
|
| Rate for Payer: CORVEL All Commercial |
$371.07
|
| Rate for Payer: Coventry All Commercial |
$351.12
|
| Rate for Payer: Encore All Commercial |
$367.28
|
| Rate for Payer: Frontpath All Commercial |
$367.08
|
| Rate for Payer: Humana ChoiceCare |
$344.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$359.10
|
| Rate for Payer: PHCS All Commercial |
$299.25
|
| Rate for Payer: PHP All Commercial |
$302.60
|
| Rate for Payer: Sagamore Health Network All Products |
$308.03
|
| Rate for Payer: Signature Care EPO |
$331.17
|
| Rate for Payer: Signature Care PPO |
$351.12
|
| Rate for Payer: United Healthcare Commercial |
$314.41
|
|
|
HC Z BLADE SAW OSC 25X90X1.37G
|
Facility
|
OP
|
$455.00
|
|
| Hospital Charge Code |
41606377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$384.02
|
| Rate for Payer: Aetna Medicare |
$145.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$261.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$284.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.16
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Centivo All Commercial |
$247.52
|
| Rate for Payer: Cigna All Commercial |
$392.67
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Humana Medicare |
$145.60
|
| Rate for Payer: Lucent All Commercial |
$247.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.45
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$386.75
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
| Rate for Payer: United Healthcare Medicare |
$145.60
|
|
|
HC Z BLADE SAW OSC 25X90X1.37G
|
Facility
|
IP
|
$455.00
|
|
| Hospital Charge Code |
41606377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna All Commercial |
$392.67
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
|
|
HC Z BLADE SAW OSC 65X35X1.19
|
Facility
|
IP
|
$455.00
|
|
| Hospital Charge Code |
41606952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna All Commercial |
$392.67
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
|
|
HC Z BLADE SAW OSC 65X35X1.19
|
Facility
|
OP
|
$455.00
|
|
| Hospital Charge Code |
41606952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$384.02
|
| Rate for Payer: Aetna Medicare |
$145.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$261.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$284.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.16
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Centivo All Commercial |
$247.52
|
| Rate for Payer: Cigna All Commercial |
$392.67
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Humana Medicare |
$145.60
|
| Rate for Payer: Lucent All Commercial |
$247.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.45
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$386.75
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
| Rate for Payer: United Healthcare Medicare |
$145.60
|
|
|
HC Z BONE CUBES CANC.
|
Facility
|
OP
|
$1,390.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,293.16 |
| Rate for Payer: Aetna Commercial |
$1,173.58
|
| Rate for Payer: Aetna Medicare |
$444.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$431.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$798.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$869.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$511.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$489.46
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Centivo All Commercial |
$756.43
|
| Rate for Payer: Cigna All Commercial |
$1,200.00
|
| Rate for Payer: CORVEL All Commercial |
$1,293.16
|
| Rate for Payer: Coventry All Commercial |
$1,223.64
|
| Rate for Payer: Encore All Commercial |
$1,279.96
|
| Rate for Payer: Frontpath All Commercial |
$1,279.26
|
| Rate for Payer: Humana ChoiceCare |
$1,200.97
|
| Rate for Payer: Humana Medicare |
$444.96
|
| Rate for Payer: Lucent All Commercial |
$756.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,251.45
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,042.88
|
| Rate for Payer: PHP All Commercial |
$1,054.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$542.29
|
| Rate for Payer: Sagamore Health Network All Products |
$1,073.47
|
| Rate for Payer: Signature Care EPO |
$1,154.12
|
| Rate for Payer: Signature Care PPO |
$1,223.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,181.92
|
| Rate for Payer: United Healthcare Commercial |
$1,095.71
|
| Rate for Payer: United Healthcare Medicare |
$444.96
|
|
|
HC Z BONE CUBES CANC.
|
Facility
|
IP
|
$1,390.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.88 |
| Max. Negotiated Rate |
$1,293.16 |
| Rate for Payer: Aetna Commercial |
$1,201.39
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cigna All Commercial |
$1,200.00
|
| Rate for Payer: CORVEL All Commercial |
$1,293.16
|
| Rate for Payer: Coventry All Commercial |
$1,223.64
|
| Rate for Payer: Encore All Commercial |
$1,279.96
|
| Rate for Payer: Frontpath All Commercial |
$1,279.26
|
| Rate for Payer: Humana ChoiceCare |
$1,200.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,251.45
|
| Rate for Payer: PHCS All Commercial |
$1,042.88
|
| Rate for Payer: PHP All Commercial |
$1,054.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,073.47
|
| Rate for Payer: Signature Care EPO |
$1,154.12
|
| Rate for Payer: Signature Care PPO |
$1,223.64
|
| Rate for Payer: United Healthcare Commercial |
$1,095.71
|
|
|
HC Z CABLE GRIP W/CRIMP 1.8X635
|
Facility
|
IP
|
$1,764.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,323.26 |
| Max. Negotiated Rate |
$1,640.85 |
| Rate for Payer: Aetna Commercial |
$1,524.40
|
| Rate for Payer: Cash Price |
$1,058.61
|
| Rate for Payer: Cigna All Commercial |
$1,522.63
|
| Rate for Payer: CORVEL All Commercial |
$1,640.85
|
| Rate for Payer: Coventry All Commercial |
$1,552.63
|
| Rate for Payer: Encore All Commercial |
$1,624.08
|
| Rate for Payer: Frontpath All Commercial |
$1,623.20
|
| Rate for Payer: Humana ChoiceCare |
$1,523.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,587.91
|
| Rate for Payer: PHCS All Commercial |
$1,323.26
|
| Rate for Payer: PHP All Commercial |
$1,338.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1,362.08
|
| Rate for Payer: Signature Care EPO |
$1,464.41
|
| Rate for Payer: Signature Care PPO |
$1,552.63
|
| Rate for Payer: United Healthcare Commercial |
$1,390.31
|
|
|
HC Z CABLE GRIP W/CRIMP 1.8X635
|
Facility
|
OP
|
$1,764.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,640.85 |
| Rate for Payer: Aetna Commercial |
$1,489.11
|
| Rate for Payer: Aetna Medicare |
$564.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$546.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,013.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,102.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$649.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$621.05
|
| Rate for Payer: Cash Price |
$1,058.61
|
| Rate for Payer: Cash Price |
$1,058.61
|
| Rate for Payer: Centivo All Commercial |
$959.81
|
| Rate for Payer: Cigna All Commercial |
$1,522.63
|
| Rate for Payer: CORVEL All Commercial |
$1,640.85
|
| Rate for Payer: Coventry All Commercial |
$1,552.63
|
| Rate for Payer: Encore All Commercial |
$1,624.08
|
| Rate for Payer: Frontpath All Commercial |
$1,623.20
|
| Rate for Payer: Humana ChoiceCare |
$1,523.87
|
| Rate for Payer: Humana Medicare |
$564.59
|
| Rate for Payer: Lucent All Commercial |
$959.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,587.91
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,323.26
|
| Rate for Payer: PHP All Commercial |
$1,338.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$688.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,362.08
|
| Rate for Payer: Signature Care EPO |
$1,464.41
|
| Rate for Payer: Signature Care PPO |
$1,552.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,499.70
|
| Rate for Payer: United Healthcare Commercial |
$1,390.31
|
| Rate for Payer: United Healthcare Medicare |
$564.59
|
|
|
HC Z CEMENT MIXING SYSTEM
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
41604401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Aetna Commercial |
$531.72
|
| Rate for Payer: Aetna Medicare |
$201.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$361.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$231.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$221.76
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Centivo All Commercial |
$342.72
|
| Rate for Payer: Cigna All Commercial |
$543.69
|
| Rate for Payer: CORVEL All Commercial |
$585.90
|
| Rate for Payer: Coventry All Commercial |
$554.40
|
| Rate for Payer: Encore All Commercial |
$579.91
|
| Rate for Payer: Frontpath All Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$544.13
|
| Rate for Payer: Humana Medicare |
$201.60
|
| Rate for Payer: Lucent All Commercial |
$342.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$567.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$472.50
|
| Rate for Payer: PHP All Commercial |
$477.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.70
|
| Rate for Payer: Sagamore Health Network All Products |
$486.36
|
| Rate for Payer: Signature Care EPO |
$522.90
|
| Rate for Payer: Signature Care PPO |
$554.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$535.50
|
| Rate for Payer: United Healthcare Commercial |
$496.44
|
| Rate for Payer: United Healthcare Medicare |
$201.60
|
|
|
HC Z CEMENT MIXING SYSTEM
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
41604401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Aetna Commercial |
$544.32
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna All Commercial |
$543.69
|
| Rate for Payer: CORVEL All Commercial |
$585.90
|
| Rate for Payer: Coventry All Commercial |
$554.40
|
| Rate for Payer: Encore All Commercial |
$579.91
|
| Rate for Payer: Frontpath All Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$544.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$567.00
|
| Rate for Payer: PHCS All Commercial |
$472.50
|
| Rate for Payer: PHP All Commercial |
$477.79
|
| Rate for Payer: Sagamore Health Network All Products |
$486.36
|
| Rate for Payer: Signature Care EPO |
$522.90
|
| Rate for Payer: Signature Care PPO |
$554.40
|
| Rate for Payer: United Healthcare Commercial |
$496.44
|
|
|
HC Z CEMENT REFOBACIN
|
Facility
|
OP
|
$807.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$750.98 |
| Rate for Payer: Aetna Commercial |
$681.53
|
| Rate for Payer: Aetna Medicare |
$258.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$250.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$463.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$504.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$297.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$284.24
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Centivo All Commercial |
$439.28
|
| Rate for Payer: Cigna All Commercial |
$696.87
|
| Rate for Payer: CORVEL All Commercial |
$750.98
|
| Rate for Payer: Coventry All Commercial |
$710.60
|
| Rate for Payer: Encore All Commercial |
$743.30
|
| Rate for Payer: Frontpath All Commercial |
$742.90
|
| Rate for Payer: Humana ChoiceCare |
$697.44
|
| Rate for Payer: Humana Medicare |
$258.40
|
| Rate for Payer: Lucent All Commercial |
$439.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$726.75
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$605.62
|
| Rate for Payer: PHP All Commercial |
$612.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$314.93
|
| Rate for Payer: Sagamore Health Network All Products |
$623.39
|
| Rate for Payer: Signature Care EPO |
$670.23
|
| Rate for Payer: Signature Care PPO |
$710.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$686.38
|
| Rate for Payer: United Healthcare Commercial |
$636.31
|
| Rate for Payer: United Healthcare Medicare |
$258.40
|
|
|
HC Z CEMENT REFOBACIN
|
Facility
|
IP
|
$807.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.62 |
| Max. Negotiated Rate |
$750.98 |
| Rate for Payer: Aetna Commercial |
$697.68
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna All Commercial |
$696.87
|
| Rate for Payer: CORVEL All Commercial |
$750.98
|
| Rate for Payer: Coventry All Commercial |
$710.60
|
| Rate for Payer: Encore All Commercial |
$743.30
|
| Rate for Payer: Frontpath All Commercial |
$742.90
|
| Rate for Payer: Humana ChoiceCare |
$697.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$726.75
|
| Rate for Payer: PHCS All Commercial |
$605.62
|
| Rate for Payer: PHP All Commercial |
$612.41
|
| Rate for Payer: Sagamore Health Network All Products |
$623.39
|
| Rate for Payer: Signature Care EPO |
$670.23
|
| Rate for Payer: Signature Care PPO |
$710.60
|
| Rate for Payer: United Healthcare Commercial |
$636.31
|
|
|
HC Z COCR 12/14 28 FEM HD +3.5
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$713.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$846.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$809.60
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Centivo All Commercial |
$1,251.20
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$736.00
|
| Rate for Payer: Lucent All Commercial |
$1,251.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$736.00
|
|
|
HC Z COCR 12/14 28 FEM HD +3.5
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
