|
HC Z G7 ACETAB LNR NTL 40 G
|
Facility
|
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,801.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,745.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,071.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,981.90
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Centivo All Commercial |
$3,062.94
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$1,801.73
|
| Rate for Payer: Lucent All Commercial |
$3,062.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,801.73
|
|
|
HC Z G 7 DUAL MOB LINER 46
|
Facility
|
IP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.80 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,864.67
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
|
|
HC Z G 7 DUAL MOB LINER 46
|
Facility
|
OP
|
$5,630.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,236.27 |
| Rate for Payer: Aetna Commercial |
$4,752.06
|
| Rate for Payer: Aetna Medicare |
$1,801.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,745.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,233.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,519.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,071.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,981.90
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Cash Price |
$3,378.24
|
| Rate for Payer: Centivo All Commercial |
$3,062.94
|
| Rate for Payer: Cigna All Commercial |
$4,859.04
|
| Rate for Payer: CORVEL All Commercial |
$5,236.27
|
| Rate for Payer: Coventry All Commercial |
$4,954.75
|
| Rate for Payer: Encore All Commercial |
$5,182.78
|
| Rate for Payer: Frontpath All Commercial |
$5,179.97
|
| Rate for Payer: Humana ChoiceCare |
$4,862.98
|
| Rate for Payer: Humana Medicare |
$1,801.73
|
| Rate for Payer: Lucent All Commercial |
$3,062.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,067.36
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,222.80
|
| Rate for Payer: PHP All Commercial |
$4,270.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,195.86
|
| Rate for Payer: Sagamore Health Network All Products |
$4,346.67
|
| Rate for Payer: Signature Care EPO |
$4,673.23
|
| Rate for Payer: Signature Care PPO |
$4,954.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,785.84
|
| Rate for Payer: United Healthcare Commercial |
$4,436.76
|
| Rate for Payer: United Healthcare Medicare |
$1,801.73
|
|
|
HC Z G7 OSSEOTI 3-H SHELL 46 B
|
Facility
|
IP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,111.32 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,496.23
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
|
|
HC Z G7 OSSEOTI 3-H SHELL 46 B
|
Facility
|
OP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,253.27
|
| Rate for Payer: Aetna Medicare |
$3,887.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,766.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,976.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,593.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,470.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,276.24
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Centivo All Commercial |
$6,608.74
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Humana Medicare |
$3,887.49
|
| Rate for Payer: Lucent All Commercial |
$6,608.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,737.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,326.16
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
| Rate for Payer: United Healthcare Medicare |
$3,887.49
|
|
|
HC Z G7 OSSEOTI 3-H SHELL 48 C
|
Facility
|
IP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,111.32 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,496.23
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
|
|
HC Z G7 OSSEOTI 3-H SHELL 48 C
|
Facility
|
OP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,253.27
|
| Rate for Payer: Aetna Medicare |
$3,887.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,766.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,976.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,593.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,470.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,276.24
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Centivo All Commercial |
$6,608.74
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Humana Medicare |
$3,887.49
|
| Rate for Payer: Lucent All Commercial |
$6,608.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,737.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,326.16
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
| Rate for Payer: United Healthcare Medicare |
$3,887.49
|
|
|
HC Z G7 OSSEOTI 3H SHELL 50D
|
Facility
|
OP
|
$12,148.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,253.27
|
| Rate for Payer: Aetna Medicare |
$3,887.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,766.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,976.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,593.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,470.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,276.24
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Centivo All Commercial |
$6,608.74
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Humana Medicare |
$3,887.49
|
| Rate for Payer: Lucent All Commercial |
$6,608.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,737.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,326.16
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
| Rate for Payer: United Healthcare Medicare |
$3,887.49
|
|
|
HC Z G7 OSSEOTI 3H SHELL 50D
|
Facility
|
IP
|
$12,148.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,111.32 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,496.23
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
|
|
HC Z G7 OSSEOTI 3-H SHELL 52 E
|
Facility
|
OP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,253.27
|
| Rate for Payer: Aetna Medicare |
$3,887.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,766.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,976.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,593.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,470.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,276.24
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Centivo All Commercial |
$6,608.74
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Humana Medicare |
$3,887.49
|
| Rate for Payer: Lucent All Commercial |
$6,608.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,737.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,326.16
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
| Rate for Payer: United Healthcare Medicare |
$3,887.49
|
|
|
HC Z G7 OSSEOTI 3-H SHELL 52 E
|
Facility
|
IP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,111.32 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,496.23
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
|
|
HC Z G7 OSSEOTI 4-H SHELL 54 F
|
Facility
|
OP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,253.27
|
| Rate for Payer: Aetna Medicare |
$3,887.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,766.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,976.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,593.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,470.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,276.24
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Centivo All Commercial |
$6,608.74
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Humana Medicare |
$3,887.49
|
| Rate for Payer: Lucent All Commercial |
$6,608.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,737.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,326.16
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
| Rate for Payer: United Healthcare Medicare |
$3,887.49
|
|
|
HC Z G7 OSSEOTI 4-H SHELL 54 F
|
Facility
|
IP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,111.32 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,496.23
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
|
|
HC Z G7 OSSEOTI 4-H SHELL 56 F
|
Facility
|
IP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,111.32 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,496.23
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
|
|
HC Z G7 OSSEOTI 4-H SHELL 56 F
|
Facility
|
OP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,253.27
|
| Rate for Payer: Aetna Medicare |
$3,887.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,766.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,976.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,593.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,470.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,276.24
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Centivo All Commercial |
$6,608.74
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Humana Medicare |
$3,887.49
|
| Rate for Payer: Lucent All Commercial |
$6,608.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,737.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,326.16
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
| Rate for Payer: United Healthcare Medicare |
$3,887.49
|
|
|
HC Z G 7 OSSEOTI 4H SHELL 58
|
Facility
|
IP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,111.32 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,496.23
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
|
|
HC Z G 7 OSSEOTI 4H SHELL 58
|
Facility
|
OP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,253.27
|
| Rate for Payer: Aetna Medicare |
$3,887.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,766.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,976.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,593.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,470.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,276.24
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Centivo All Commercial |
$6,608.74
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Humana Medicare |
$3,887.49
|
| Rate for Payer: Lucent All Commercial |
$6,608.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,737.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,326.16
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
| Rate for Payer: United Healthcare Medicare |
$3,887.49
|
|
|
HC Z G7 OSSEOTI 4-H SHELL 60 G
|
Facility
|
OP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,253.27
|
| Rate for Payer: Aetna Medicare |
$3,887.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,766.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,976.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,593.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,470.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,276.24
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Centivo All Commercial |
$6,608.74
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Humana Medicare |
$3,887.49
|
| Rate for Payer: Lucent All Commercial |
$6,608.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,737.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,326.16
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
| Rate for Payer: United Healthcare Medicare |
$3,887.49
|
|
|
HC Z G7 OSSEOTI 4-H SHELL 60 G
|
Facility
|
IP
|
$12,148.42
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,111.32 |
| Max. Negotiated Rate |
$11,298.03 |
| Rate for Payer: Aetna Commercial |
$10,496.23
|
| Rate for Payer: Cash Price |
$7,289.05
|
| Rate for Payer: Cigna All Commercial |
$10,484.09
|
| Rate for Payer: CORVEL All Commercial |
$11,298.03
|
| Rate for Payer: Coventry All Commercial |
$10,690.61
|
| Rate for Payer: Encore All Commercial |
$11,182.62
|
| Rate for Payer: Frontpath All Commercial |
$11,176.55
|
| Rate for Payer: Humana ChoiceCare |
$10,492.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,933.58
|
| Rate for Payer: PHCS All Commercial |
$9,111.32
|
| Rate for Payer: PHP All Commercial |
$9,213.36
|
| Rate for Payer: Sagamore Health Network All Products |
$9,378.58
|
| Rate for Payer: Signature Care EPO |
$10,083.19
|
| Rate for Payer: Signature Care PPO |
$10,690.61
|
| Rate for Payer: United Healthcare Commercial |
$9,572.95
|
|
|
HC Z GENEX BONE GRAFT 5CC
|
Facility
|
IP
|
$6,756.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,067.58 |
| Max. Negotiated Rate |
$6,283.80 |
| Rate for Payer: Aetna Commercial |
$5,837.85
|
| Rate for Payer: Cash Price |
$4,054.06
|
| Rate for Payer: Cigna All Commercial |
$5,831.09
|
| Rate for Payer: CORVEL All Commercial |
$6,283.80
|
| Rate for Payer: Coventry All Commercial |
$5,945.96
|
| Rate for Payer: Encore All Commercial |
$6,219.61
|
| Rate for Payer: Frontpath All Commercial |
$6,216.23
|
| Rate for Payer: Humana ChoiceCare |
$5,835.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,081.09
|
| Rate for Payer: PHCS All Commercial |
$5,067.58
|
| Rate for Payer: PHP All Commercial |
$5,124.33
|
| Rate for Payer: Sagamore Health Network All Products |
$5,216.23
|
| Rate for Payer: Signature Care EPO |
$5,608.12
|
| Rate for Payer: Signature Care PPO |
$5,945.96
|
| Rate for Payer: United Healthcare Commercial |
$5,324.33
|
|
|
HC Z GENEX BONE GRAFT 5CC
|
Facility
|
OP
|
$6,756.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,283.80 |
| Rate for Payer: Aetna Commercial |
$5,702.71
|
| Rate for Payer: Aetna Medicare |
$2,162.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,094.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,880.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,223.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,486.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,378.38
|
| Rate for Payer: Cash Price |
$4,054.06
|
| Rate for Payer: Cash Price |
$4,054.06
|
| Rate for Payer: Centivo All Commercial |
$3,675.68
|
| Rate for Payer: Cigna All Commercial |
$5,831.09
|
| Rate for Payer: CORVEL All Commercial |
$6,283.80
|
| Rate for Payer: Coventry All Commercial |
$5,945.96
|
| Rate for Payer: Encore All Commercial |
$6,219.61
|
| Rate for Payer: Frontpath All Commercial |
$6,216.23
|
| Rate for Payer: Humana ChoiceCare |
$5,835.82
|
| Rate for Payer: Humana Medicare |
$2,162.17
|
| Rate for Payer: Lucent All Commercial |
$3,675.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,081.09
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$5,067.58
|
| Rate for Payer: PHP All Commercial |
$5,124.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,635.14
|
| Rate for Payer: Sagamore Health Network All Products |
$5,216.23
|
| Rate for Payer: Signature Care EPO |
$5,608.12
|
| Rate for Payer: Signature Care PPO |
$5,945.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,743.25
|
| Rate for Payer: United Healthcare Commercial |
$5,324.33
|
| Rate for Payer: United Healthcare Medicare |
$2,162.17
|
|
|
HC Z GLEN MOD 4 PEG SZ 3
|
Facility
|
OP
|
$5,325.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,952.90 |
| Rate for Payer: Aetna Commercial |
$4,494.89
|
| Rate for Payer: Aetna Medicare |
$1,704.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,650.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,058.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,329.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,959.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,874.65
|
| Rate for Payer: Cash Price |
$3,195.42
|
| Rate for Payer: Cash Price |
$3,195.42
|
| Rate for Payer: Centivo All Commercial |
$2,897.18
|
| Rate for Payer: Cigna All Commercial |
$4,596.08
|
| Rate for Payer: CORVEL All Commercial |
$4,952.90
|
| Rate for Payer: Coventry All Commercial |
$4,686.62
|
| Rate for Payer: Encore All Commercial |
$4,902.31
|
| Rate for Payer: Frontpath All Commercial |
$4,899.64
|
| Rate for Payer: Humana ChoiceCare |
$4,599.81
|
| Rate for Payer: Humana Medicare |
$1,704.22
|
| Rate for Payer: Lucent All Commercial |
$2,897.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,793.13
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,994.28
|
| Rate for Payer: PHP All Commercial |
$4,039.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,077.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,111.44
|
| Rate for Payer: Signature Care EPO |
$4,420.33
|
| Rate for Payer: Signature Care PPO |
$4,686.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,526.85
|
| Rate for Payer: United Healthcare Commercial |
$4,196.65
|
| Rate for Payer: United Healthcare Medicare |
$1,704.22
|
|
|
HC Z GLEN MOD 4 PEG SZ 3
|
Facility
|
IP
|
$5,325.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,994.28 |
| Max. Negotiated Rate |
$4,952.90 |
| Rate for Payer: Aetna Commercial |
$4,601.40
|
| Rate for Payer: Cash Price |
$3,195.42
|
| Rate for Payer: Cigna All Commercial |
$4,596.08
|
| Rate for Payer: CORVEL All Commercial |
$4,952.90
|
| Rate for Payer: Coventry All Commercial |
$4,686.62
|
| Rate for Payer: Encore All Commercial |
$4,902.31
|
| Rate for Payer: Frontpath All Commercial |
$4,899.64
|
| Rate for Payer: Humana ChoiceCare |
$4,599.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,793.13
|
| Rate for Payer: PHCS All Commercial |
$3,994.28
|
| Rate for Payer: PHP All Commercial |
$4,039.01
|
| Rate for Payer: Sagamore Health Network All Products |
$4,111.44
|
| Rate for Payer: Signature Care EPO |
$4,420.33
|
| Rate for Payer: Signature Care PPO |
$4,686.62
|
| Rate for Payer: United Healthcare Commercial |
$4,196.65
|
|
|
HC Z GLEN MOD POST
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607034
|
|
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
|
|
|
HC Z GLEN MOD POST
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607034
|
|
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
|
|
