|
HC Z HMRL BEARING 36MM STD PRLNG
|
Facility
|
IP
|
$6,660.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,995.00 |
| Max. Negotiated Rate |
$6,193.80 |
| Rate for Payer: Aetna Commercial |
$5,754.24
|
| Rate for Payer: Cash Price |
$3,996.00
|
| Rate for Payer: Cigna All Commercial |
$5,747.58
|
| Rate for Payer: CORVEL All Commercial |
$6,193.80
|
| Rate for Payer: Coventry All Commercial |
$5,860.80
|
| Rate for Payer: Encore All Commercial |
$6,130.53
|
| Rate for Payer: Frontpath All Commercial |
$6,127.20
|
| Rate for Payer: Humana ChoiceCare |
$5,752.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,994.00
|
| Rate for Payer: PHCS All Commercial |
$4,995.00
|
| Rate for Payer: PHP All Commercial |
$5,050.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5,141.52
|
| Rate for Payer: Signature Care EPO |
$5,527.80
|
| Rate for Payer: Signature Care PPO |
$5,860.80
|
| Rate for Payer: United Healthcare Commercial |
$5,248.08
|
|
|
HC Z HMRL BEARING 40 STD
|
Facility
|
IP
|
$6,292.80
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,719.60 |
| Max. Negotiated Rate |
$5,852.30 |
| Rate for Payer: Aetna Commercial |
$5,436.98
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Cigna All Commercial |
$5,430.69
|
| Rate for Payer: CORVEL All Commercial |
$5,852.30
|
| Rate for Payer: Coventry All Commercial |
$5,537.66
|
| Rate for Payer: Encore All Commercial |
$5,792.52
|
| Rate for Payer: Frontpath All Commercial |
$5,789.38
|
| Rate for Payer: Humana ChoiceCare |
$5,435.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,663.52
|
| Rate for Payer: PHCS All Commercial |
$4,719.60
|
| Rate for Payer: PHP All Commercial |
$4,772.46
|
| Rate for Payer: Sagamore Health Network All Products |
$4,858.04
|
| Rate for Payer: Signature Care EPO |
$5,223.02
|
| Rate for Payer: Signature Care PPO |
$5,537.66
|
| Rate for Payer: United Healthcare Commercial |
$4,958.73
|
|
|
HC Z HMRL BEARING 40 STD
|
Facility
|
OP
|
$6,292.80
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,852.30 |
| Rate for Payer: Aetna Commercial |
$5,311.12
|
| Rate for Payer: Aetna Medicare |
$2,013.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,950.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,613.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,933.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,315.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,215.07
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Centivo All Commercial |
$3,423.28
|
| Rate for Payer: Cigna All Commercial |
$5,430.69
|
| Rate for Payer: CORVEL All Commercial |
$5,852.30
|
| Rate for Payer: Coventry All Commercial |
$5,537.66
|
| Rate for Payer: Encore All Commercial |
$5,792.52
|
| Rate for Payer: Frontpath All Commercial |
$5,789.38
|
| Rate for Payer: Humana ChoiceCare |
$5,435.09
|
| Rate for Payer: Humana Medicare |
$2,013.70
|
| Rate for Payer: Lucent All Commercial |
$3,423.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,663.52
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,719.60
|
| Rate for Payer: PHP All Commercial |
$4,772.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,454.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4,858.04
|
| Rate for Payer: Signature Care EPO |
$5,223.02
|
| Rate for Payer: Signature Care PPO |
$5,537.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,348.88
|
| Rate for Payer: United Healthcare Commercial |
$4,958.73
|
| Rate for Payer: United Healthcare Medicare |
$2,013.70
|
|
|
HC Z HMRL BERAING 36MM STD
|
Facility
|
OP
|
$6,292.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$5,852.30 |
| Rate for Payer: Aetna Commercial |
$5,311.12
|
| Rate for Payer: Aetna Medicare |
$2,013.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,950.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,613.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,933.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,315.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,215.07
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Centivo All Commercial |
$3,423.28
|
| Rate for Payer: Cigna All Commercial |
$5,430.69
|
| Rate for Payer: CORVEL All Commercial |
$5,852.30
|
| Rate for Payer: Coventry All Commercial |
$5,537.66
|
| Rate for Payer: Encore All Commercial |
$5,792.52
|
| Rate for Payer: Frontpath All Commercial |
$5,789.38
|
| Rate for Payer: Humana ChoiceCare |
$5,435.09
|
| Rate for Payer: Humana Medicare |
$2,013.70
|
| Rate for Payer: Lucent All Commercial |
$3,423.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,663.52
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$4,719.60
|
| Rate for Payer: PHP All Commercial |
$4,772.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,454.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4,858.04
|
| Rate for Payer: Signature Care EPO |
$5,223.02
|
| Rate for Payer: Signature Care PPO |
$5,537.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,348.88
|
| Rate for Payer: United Healthcare Commercial |
$4,958.73
|
| Rate for Payer: United Healthcare Medicare |
$2,013.70
|
|
|
HC Z HMRL BERAING 36MM STD
|
Facility
|
IP
|
$6,292.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,719.60 |
| Max. Negotiated Rate |
$5,852.30 |
| Rate for Payer: Aetna Commercial |
$5,436.98
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Cigna All Commercial |
$5,430.69
|
| Rate for Payer: CORVEL All Commercial |
$5,852.30
|
| Rate for Payer: Coventry All Commercial |
$5,537.66
|
| Rate for Payer: Encore All Commercial |
$5,792.52
|
| Rate for Payer: Frontpath All Commercial |
$5,789.38
|
| Rate for Payer: Humana ChoiceCare |
$5,435.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,663.52
|
| Rate for Payer: PHCS All Commercial |
$4,719.60
|
| Rate for Payer: PHP All Commercial |
$4,772.46
|
| Rate for Payer: Sagamore Health Network All Products |
$4,858.04
|
| Rate for Payer: Signature Care EPO |
$5,223.02
|
| Rate for Payer: Signature Care PPO |
$5,537.66
|
| Rate for Payer: United Healthcare Commercial |
$4,958.73
|
|
|
HC Z HMRL STEMLESS NANO 34
|
Facility
|
IP
|
$29,862.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,396.50 |
| Max. Negotiated Rate |
$27,771.66 |
| Rate for Payer: Aetna Commercial |
$25,800.77
|
| Rate for Payer: Cash Price |
$17,917.20
|
| Rate for Payer: Cigna All Commercial |
$25,770.91
|
| Rate for Payer: CORVEL All Commercial |
$27,771.66
|
| Rate for Payer: Coventry All Commercial |
$26,278.56
|
| Rate for Payer: Encore All Commercial |
$27,487.97
|
| Rate for Payer: Frontpath All Commercial |
$27,473.04
|
| Rate for Payer: Humana ChoiceCare |
$25,791.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26,875.80
|
| Rate for Payer: PHCS All Commercial |
$22,396.50
|
| Rate for Payer: PHP All Commercial |
$22,647.34
|
| Rate for Payer: Sagamore Health Network All Products |
$23,053.46
|
| Rate for Payer: Signature Care EPO |
$24,785.46
|
| Rate for Payer: Signature Care PPO |
$26,278.56
|
| Rate for Payer: United Healthcare Commercial |
$23,531.26
|
|
|
HC Z HMRL STEMLESS NANO 34
|
Facility
|
OP
|
$29,862.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$27,771.66 |
| Rate for Payer: Aetna Commercial |
$25,203.53
|
| Rate for Payer: Aetna Medicare |
$9,555.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,257.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17,149.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18,666.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,989.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10,511.42
|
| Rate for Payer: Cash Price |
$17,917.20
|
| Rate for Payer: Cash Price |
$17,917.20
|
| Rate for Payer: Centivo All Commercial |
$16,244.93
|
| Rate for Payer: Cigna All Commercial |
$25,770.91
|
| Rate for Payer: CORVEL All Commercial |
$27,771.66
|
| Rate for Payer: Coventry All Commercial |
$26,278.56
|
| Rate for Payer: Encore All Commercial |
$27,487.97
|
| Rate for Payer: Frontpath All Commercial |
$27,473.04
|
| Rate for Payer: Humana ChoiceCare |
$25,791.81
|
| Rate for Payer: Humana Medicare |
$9,555.84
|
| Rate for Payer: Lucent All Commercial |
$16,244.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26,875.80
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$22,396.50
|
| Rate for Payer: PHP All Commercial |
$22,647.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11,646.18
|
| Rate for Payer: Sagamore Health Network All Products |
$23,053.46
|
| Rate for Payer: Signature Care EPO |
$24,785.46
|
| Rate for Payer: Signature Care PPO |
$26,278.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,382.70
|
| Rate for Payer: United Healthcare Commercial |
$23,531.26
|
| Rate for Payer: United Healthcare Medicare |
$9,555.84
|
|
|
HC Z HMRL STEMLESS NANO 36
|
Facility
|
OP
|
$29,862.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$27,771.66 |
| Rate for Payer: Aetna Commercial |
$25,203.53
|
| Rate for Payer: Aetna Medicare |
$9,555.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9,257.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17,149.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18,666.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10,989.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10,511.42
|
| Rate for Payer: Cash Price |
$17,917.20
|
| Rate for Payer: Cash Price |
$17,917.20
|
| Rate for Payer: Centivo All Commercial |
$16,244.93
|
| Rate for Payer: Cigna All Commercial |
$25,770.91
|
| Rate for Payer: CORVEL All Commercial |
$27,771.66
|
| Rate for Payer: Coventry All Commercial |
$26,278.56
|
| Rate for Payer: Encore All Commercial |
$27,487.97
|
| Rate for Payer: Frontpath All Commercial |
$27,473.04
|
| Rate for Payer: Humana ChoiceCare |
$25,791.81
|
| Rate for Payer: Humana Medicare |
$9,555.84
|
| Rate for Payer: Lucent All Commercial |
$16,244.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26,875.80
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$22,396.50
|
| Rate for Payer: PHP All Commercial |
$22,647.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11,646.18
|
| Rate for Payer: Sagamore Health Network All Products |
$23,053.46
|
| Rate for Payer: Signature Care EPO |
$24,785.46
|
| Rate for Payer: Signature Care PPO |
$26,278.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,382.70
|
| Rate for Payer: United Healthcare Commercial |
$23,531.26
|
| Rate for Payer: United Healthcare Medicare |
$9,555.84
|
|
|
HC Z HMRL STEMLESS NANO 36
|
Facility
|
IP
|
$29,862.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,396.50 |
| Max. Negotiated Rate |
$27,771.66 |
| Rate for Payer: Aetna Commercial |
$25,800.77
|
| Rate for Payer: Cash Price |
$17,917.20
|
| Rate for Payer: Cigna All Commercial |
$25,770.91
|
| Rate for Payer: CORVEL All Commercial |
$27,771.66
|
| Rate for Payer: Coventry All Commercial |
$26,278.56
|
| Rate for Payer: Encore All Commercial |
$27,487.97
|
| Rate for Payer: Frontpath All Commercial |
$27,473.04
|
| Rate for Payer: Humana ChoiceCare |
$25,791.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26,875.80
|
| Rate for Payer: PHCS All Commercial |
$22,396.50
|
| Rate for Payer: PHP All Commercial |
$22,647.34
|
| Rate for Payer: Sagamore Health Network All Products |
$23,053.46
|
| Rate for Payer: Signature Care EPO |
$24,785.46
|
| Rate for Payer: Signature Care PPO |
$26,278.56
|
| Rate for Payer: United Healthcare Commercial |
$23,531.26
|
|
|
HC Z HMRL TRAY 40MM +5
|
Facility
|
OP
|
$5,034.24
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,681.84 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Aetna Medicare |
$1,610.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,560.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,891.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,146.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,852.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,772.05
|
| Rate for Payer: Cash Price |
$3,020.54
|
| Rate for Payer: Cash Price |
$3,020.54
|
| Rate for Payer: Centivo All Commercial |
$2,738.63
|
| Rate for Payer: Cigna All Commercial |
$4,344.55
|
| Rate for Payer: CORVEL All Commercial |
$4,681.84
|
| Rate for Payer: Coventry All Commercial |
$4,430.13
|
| Rate for Payer: Encore All Commercial |
$4,634.02
|
| Rate for Payer: Frontpath All Commercial |
$4,631.50
|
| Rate for Payer: Humana ChoiceCare |
$4,348.07
|
| Rate for Payer: Humana Medicare |
$1,610.96
|
| Rate for Payer: Lucent All Commercial |
$2,738.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,530.82
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,775.68
|
| Rate for Payer: PHP All Commercial |
$3,817.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,963.35
|
| Rate for Payer: Sagamore Health Network All Products |
$3,886.43
|
| Rate for Payer: Signature Care EPO |
$4,178.42
|
| Rate for Payer: Signature Care PPO |
$4,430.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,279.10
|
| Rate for Payer: United Healthcare Commercial |
$3,966.98
|
| Rate for Payer: United Healthcare Medicare |
$1,610.96
|
|
|
HC Z HMRL TRAY 40MM +5
|
Facility
|
IP
|
$5,034.24
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.68 |
| Max. Negotiated Rate |
$4,681.84 |
| Rate for Payer: Aetna Commercial |
$4,349.58
|
| Rate for Payer: Cash Price |
$3,020.54
|
| Rate for Payer: Cigna All Commercial |
$4,344.55
|
| Rate for Payer: CORVEL All Commercial |
$4,681.84
|
| Rate for Payer: Coventry All Commercial |
$4,430.13
|
| Rate for Payer: Encore All Commercial |
$4,634.02
|
| Rate for Payer: Frontpath All Commercial |
$4,631.50
|
| Rate for Payer: Humana ChoiceCare |
$4,348.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,530.82
|
| Rate for Payer: PHCS All Commercial |
$3,775.68
|
| Rate for Payer: PHP All Commercial |
$3,817.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3,886.43
|
| Rate for Payer: Signature Care EPO |
$4,178.42
|
| Rate for Payer: Signature Care PPO |
$4,430.13
|
| Rate for Payer: United Healthcare Commercial |
$3,966.98
|
|
|
HC Z HMRL TRAY MINI 40 +3+5
|
Facility
|
IP
|
$5,299.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,974.40 |
| Max. Negotiated Rate |
$4,928.26 |
| Rate for Payer: Aetna Commercial |
$4,578.51
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Cigna All Commercial |
$4,573.21
|
| Rate for Payer: CORVEL All Commercial |
$4,928.26
|
| Rate for Payer: Coventry All Commercial |
$4,663.30
|
| Rate for Payer: Encore All Commercial |
$4,877.91
|
| Rate for Payer: Frontpath All Commercial |
$4,875.26
|
| Rate for Payer: Humana ChoiceCare |
$4,576.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,769.28
|
| Rate for Payer: PHCS All Commercial |
$3,974.40
|
| Rate for Payer: PHP All Commercial |
$4,018.91
|
| Rate for Payer: Sagamore Health Network All Products |
$4,090.98
|
| Rate for Payer: Signature Care EPO |
$4,398.34
|
| Rate for Payer: Signature Care PPO |
$4,663.30
|
| Rate for Payer: United Healthcare Commercial |
$4,175.77
|
|
|
HC Z HMRL TRAY MINI 40 +3+5
|
Facility
|
OP
|
$5,299.20
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,928.26 |
| Rate for Payer: Aetna Commercial |
$4,472.52
|
| Rate for Payer: Aetna Medicare |
$1,695.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,642.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,043.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,312.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,950.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,865.32
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Centivo All Commercial |
$2,882.76
|
| Rate for Payer: Cigna All Commercial |
$4,573.21
|
| Rate for Payer: CORVEL All Commercial |
$4,928.26
|
| Rate for Payer: Coventry All Commercial |
$4,663.30
|
| Rate for Payer: Encore All Commercial |
$4,877.91
|
| Rate for Payer: Frontpath All Commercial |
$4,875.26
|
| Rate for Payer: Humana ChoiceCare |
$4,576.92
|
| Rate for Payer: Humana Medicare |
$1,695.74
|
| Rate for Payer: Lucent All Commercial |
$2,882.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,769.28
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,974.40
|
| Rate for Payer: PHP All Commercial |
$4,018.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,066.69
|
| Rate for Payer: Sagamore Health Network All Products |
$4,090.98
|
| Rate for Payer: Signature Care EPO |
$4,398.34
|
| Rate for Payer: Signature Care PPO |
$4,663.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,504.32
|
| Rate for Payer: United Healthcare Commercial |
$4,175.77
|
| Rate for Payer: United Healthcare Medicare |
$1,695.74
|
|
|
HC Z HMRL TRAY STD 40MM
|
Facility
|
IP
|
$5,299.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,974.40 |
| Max. Negotiated Rate |
$4,928.26 |
| Rate for Payer: Aetna Commercial |
$4,578.51
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Cigna All Commercial |
$4,573.21
|
| Rate for Payer: CORVEL All Commercial |
$4,928.26
|
| Rate for Payer: Coventry All Commercial |
$4,663.30
|
| Rate for Payer: Encore All Commercial |
$4,877.91
|
| Rate for Payer: Frontpath All Commercial |
$4,875.26
|
| Rate for Payer: Humana ChoiceCare |
$4,576.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,769.28
|
| Rate for Payer: PHCS All Commercial |
$3,974.40
|
| Rate for Payer: PHP All Commercial |
$4,018.91
|
| Rate for Payer: Sagamore Health Network All Products |
$4,090.98
|
| Rate for Payer: Signature Care EPO |
$4,398.34
|
| Rate for Payer: Signature Care PPO |
$4,663.30
|
| Rate for Payer: United Healthcare Commercial |
$4,175.77
|
|
|
HC Z HMRL TRAY STD 40MM
|
Facility
|
OP
|
$5,299.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,928.26 |
| Rate for Payer: Aetna Commercial |
$4,472.52
|
| Rate for Payer: Aetna Medicare |
$1,695.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,642.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,043.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,312.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,950.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,865.32
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Centivo All Commercial |
$2,882.76
|
| Rate for Payer: Cigna All Commercial |
$4,573.21
|
| Rate for Payer: CORVEL All Commercial |
$4,928.26
|
| Rate for Payer: Coventry All Commercial |
$4,663.30
|
| Rate for Payer: Encore All Commercial |
$4,877.91
|
| Rate for Payer: Frontpath All Commercial |
$4,875.26
|
| Rate for Payer: Humana ChoiceCare |
$4,576.92
|
| Rate for Payer: Humana Medicare |
$1,695.74
|
| Rate for Payer: Lucent All Commercial |
$2,882.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,769.28
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,974.40
|
| Rate for Payer: PHP All Commercial |
$4,018.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,066.69
|
| Rate for Payer: Sagamore Health Network All Products |
$4,090.98
|
| Rate for Payer: Signature Care EPO |
$4,398.34
|
| Rate for Payer: Signature Care PPO |
$4,663.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,504.32
|
| Rate for Payer: United Healthcare Commercial |
$4,175.77
|
| Rate for Payer: United Healthcare Medicare |
$1,695.74
|
|
|
HC Z HMRL TRAY STD 40MM +3
|
Facility
|
OP
|
$5,299.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,928.26 |
| Rate for Payer: Aetna Commercial |
$4,472.52
|
| Rate for Payer: Aetna Medicare |
$1,695.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,642.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,043.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,312.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,950.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,865.32
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Centivo All Commercial |
$2,882.76
|
| Rate for Payer: Cigna All Commercial |
$4,573.21
|
| Rate for Payer: CORVEL All Commercial |
$4,928.26
|
| Rate for Payer: Coventry All Commercial |
$4,663.30
|
| Rate for Payer: Encore All Commercial |
$4,877.91
|
| Rate for Payer: Frontpath All Commercial |
$4,875.26
|
| Rate for Payer: Humana ChoiceCare |
$4,576.92
|
| Rate for Payer: Humana Medicare |
$1,695.74
|
| Rate for Payer: Lucent All Commercial |
$2,882.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,769.28
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,974.40
|
| Rate for Payer: PHP All Commercial |
$4,018.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,066.69
|
| Rate for Payer: Sagamore Health Network All Products |
$4,090.98
|
| Rate for Payer: Signature Care EPO |
$4,398.34
|
| Rate for Payer: Signature Care PPO |
$4,663.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,504.32
|
| Rate for Payer: United Healthcare Commercial |
$4,175.77
|
| Rate for Payer: United Healthcare Medicare |
$1,695.74
|
|
|
HC Z HMRL TRAY STD 40MM +3
|
Facility
|
IP
|
$5,299.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,974.40 |
| Max. Negotiated Rate |
$4,928.26 |
| Rate for Payer: Aetna Commercial |
$4,578.51
|
| Rate for Payer: Cash Price |
$3,179.52
|
| Rate for Payer: Cigna All Commercial |
$4,573.21
|
| Rate for Payer: CORVEL All Commercial |
$4,928.26
|
| Rate for Payer: Coventry All Commercial |
$4,663.30
|
| Rate for Payer: Encore All Commercial |
$4,877.91
|
| Rate for Payer: Frontpath All Commercial |
$4,875.26
|
| Rate for Payer: Humana ChoiceCare |
$4,576.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,769.28
|
| Rate for Payer: PHCS All Commercial |
$3,974.40
|
| Rate for Payer: PHP All Commercial |
$4,018.91
|
| Rate for Payer: Sagamore Health Network All Products |
$4,090.98
|
| Rate for Payer: Signature Care EPO |
$4,398.34
|
| Rate for Payer: Signature Care PPO |
$4,663.30
|
| Rate for Payer: United Healthcare Commercial |
$4,175.77
|
|
|
HC Z HUMERAL BRG 36 VITE +3
|
Facility
|
OP
|
$6,292.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,852.30 |
| Rate for Payer: Aetna Commercial |
$5,311.12
|
| Rate for Payer: Aetna Medicare |
$2,013.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,950.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,613.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,933.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,315.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,215.07
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Centivo All Commercial |
$3,423.28
|
| Rate for Payer: Cigna All Commercial |
$5,430.69
|
| Rate for Payer: CORVEL All Commercial |
$5,852.30
|
| Rate for Payer: Coventry All Commercial |
$5,537.66
|
| Rate for Payer: Encore All Commercial |
$5,792.52
|
| Rate for Payer: Frontpath All Commercial |
$5,789.38
|
| Rate for Payer: Humana ChoiceCare |
$5,435.09
|
| Rate for Payer: Humana Medicare |
$2,013.70
|
| Rate for Payer: Lucent All Commercial |
$3,423.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,663.52
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,719.60
|
| Rate for Payer: PHP All Commercial |
$4,772.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,454.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4,858.04
|
| Rate for Payer: Signature Care EPO |
$5,223.02
|
| Rate for Payer: Signature Care PPO |
$5,537.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,348.88
|
| Rate for Payer: United Healthcare Commercial |
$4,958.73
|
| Rate for Payer: United Healthcare Medicare |
$2,013.70
|
|
|
HC Z HUMERAL BRG 36 VITE +3
|
Facility
|
IP
|
$6,292.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,719.60 |
| Max. Negotiated Rate |
$5,852.30 |
| Rate for Payer: Aetna Commercial |
$5,436.98
|
| Rate for Payer: Cash Price |
$3,775.68
|
| Rate for Payer: Cigna All Commercial |
$5,430.69
|
| Rate for Payer: CORVEL All Commercial |
$5,852.30
|
| Rate for Payer: Coventry All Commercial |
$5,537.66
|
| Rate for Payer: Encore All Commercial |
$5,792.52
|
| Rate for Payer: Frontpath All Commercial |
$5,789.38
|
| Rate for Payer: Humana ChoiceCare |
$5,435.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,663.52
|
| Rate for Payer: PHCS All Commercial |
$4,719.60
|
| Rate for Payer: PHP All Commercial |
$4,772.46
|
| Rate for Payer: Sagamore Health Network All Products |
$4,858.04
|
| Rate for Payer: Signature Care EPO |
$5,223.02
|
| Rate for Payer: Signature Care PPO |
$5,537.66
|
| Rate for Payer: United Healthcare Commercial |
$4,958.73
|
|
|
HC Z HUMERAL HD 46X18X53
|
Facility
|
IP
|
$6,180.19
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,635.14 |
| Max. Negotiated Rate |
$5,747.58 |
| Rate for Payer: Aetna Commercial |
$5,339.68
|
| Rate for Payer: Cash Price |
$3,708.11
|
| Rate for Payer: Cigna All Commercial |
$5,333.50
|
| Rate for Payer: CORVEL All Commercial |
$5,747.58
|
| Rate for Payer: Coventry All Commercial |
$5,438.57
|
| Rate for Payer: Encore All Commercial |
$5,688.86
|
| Rate for Payer: Frontpath All Commercial |
$5,685.77
|
| Rate for Payer: Humana ChoiceCare |
$5,337.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,562.17
|
| Rate for Payer: PHCS All Commercial |
$4,635.14
|
| Rate for Payer: PHP All Commercial |
$4,687.06
|
| Rate for Payer: Sagamore Health Network All Products |
$4,771.11
|
| Rate for Payer: Signature Care EPO |
$5,129.56
|
| Rate for Payer: Signature Care PPO |
$5,438.57
|
| Rate for Payer: United Healthcare Commercial |
$4,869.99
|
|
|
HC Z HUMERAL HD 46X18X53
|
Facility
|
OP
|
$6,180.19
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,747.58 |
| Rate for Payer: Aetna Commercial |
$5,216.08
|
| Rate for Payer: Aetna Medicare |
$1,977.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,915.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,549.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,863.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,274.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,175.43
|
| Rate for Payer: Cash Price |
$3,708.11
|
| Rate for Payer: Cash Price |
$3,708.11
|
| Rate for Payer: Centivo All Commercial |
$3,362.02
|
| Rate for Payer: Cigna All Commercial |
$5,333.50
|
| Rate for Payer: CORVEL All Commercial |
$5,747.58
|
| Rate for Payer: Coventry All Commercial |
$5,438.57
|
| Rate for Payer: Encore All Commercial |
$5,688.86
|
| Rate for Payer: Frontpath All Commercial |
$5,685.77
|
| Rate for Payer: Humana ChoiceCare |
$5,337.83
|
| Rate for Payer: Humana Medicare |
$1,977.66
|
| Rate for Payer: Lucent All Commercial |
$3,362.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,562.17
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,635.14
|
| Rate for Payer: PHP All Commercial |
$4,687.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,410.27
|
| Rate for Payer: Sagamore Health Network All Products |
$4,771.11
|
| Rate for Payer: Signature Care EPO |
$5,129.56
|
| Rate for Payer: Signature Care PPO |
$5,438.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,253.16
|
| Rate for Payer: United Healthcare Commercial |
$4,869.99
|
| Rate for Payer: United Healthcare Medicare |
$1,977.66
|
|
|
HC Z HUMERAL HD 46X21X50
|
Facility
|
OP
|
$6,180.19
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,747.58 |
| Rate for Payer: Aetna Commercial |
$5,216.08
|
| Rate for Payer: Aetna Medicare |
$1,977.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,915.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,549.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,863.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,274.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,175.43
|
| Rate for Payer: Cash Price |
$3,708.11
|
| Rate for Payer: Cash Price |
$3,708.11
|
| Rate for Payer: Centivo All Commercial |
$3,362.02
|
| Rate for Payer: Cigna All Commercial |
$5,333.50
|
| Rate for Payer: CORVEL All Commercial |
$5,747.58
|
| Rate for Payer: Coventry All Commercial |
$5,438.57
|
| Rate for Payer: Encore All Commercial |
$5,688.86
|
| Rate for Payer: Frontpath All Commercial |
$5,685.77
|
| Rate for Payer: Humana ChoiceCare |
$5,337.83
|
| Rate for Payer: Humana Medicare |
$1,977.66
|
| Rate for Payer: Lucent All Commercial |
$3,362.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,562.17
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,635.14
|
| Rate for Payer: PHP All Commercial |
$4,687.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,410.27
|
| Rate for Payer: Sagamore Health Network All Products |
$4,771.11
|
| Rate for Payer: Signature Care EPO |
$5,129.56
|
| Rate for Payer: Signature Care PPO |
$5,438.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,253.16
|
| Rate for Payer: United Healthcare Commercial |
$4,869.99
|
| Rate for Payer: United Healthcare Medicare |
$1,977.66
|
|
|
HC Z HUMERAL HD 46X21X50
|
Facility
|
IP
|
$6,180.19
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,635.14 |
| Max. Negotiated Rate |
$5,747.58 |
| Rate for Payer: Aetna Commercial |
$5,339.68
|
| Rate for Payer: Cash Price |
$3,708.11
|
| Rate for Payer: Cigna All Commercial |
$5,333.50
|
| Rate for Payer: CORVEL All Commercial |
$5,747.58
|
| Rate for Payer: Coventry All Commercial |
$5,438.57
|
| Rate for Payer: Encore All Commercial |
$5,688.86
|
| Rate for Payer: Frontpath All Commercial |
$5,685.77
|
| Rate for Payer: Humana ChoiceCare |
$5,337.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,562.17
|
| Rate for Payer: PHCS All Commercial |
$4,635.14
|
| Rate for Payer: PHP All Commercial |
$4,687.06
|
| Rate for Payer: Sagamore Health Network All Products |
$4,771.11
|
| Rate for Payer: Signature Care EPO |
$5,129.56
|
| Rate for Payer: Signature Care PPO |
$5,438.57
|
| Rate for Payer: United Healthcare Commercial |
$4,869.99
|
|
|
HC Z HUM STEM 10 MICRO
|
Facility
|
OP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$13,976.64
|
| Rate for Payer: Aetna Medicare |
$5,299.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,133.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,510.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,351.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,094.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,829.12
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Centivo All Commercial |
$9,008.64
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Humana Medicare |
$5,299.20
|
| Rate for Payer: Lucent All Commercial |
$9,008.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,458.40
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,076.00
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
| Rate for Payer: United Healthcare Medicare |
$5,299.20
|
|
|
HC Z HUM STEM 10 MICRO
|
Facility
|
IP
|
$16,560.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,420.00 |
| Max. Negotiated Rate |
$15,400.80 |
| Rate for Payer: Aetna Commercial |
$14,307.84
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cigna All Commercial |
$14,291.28
|
| Rate for Payer: CORVEL All Commercial |
$15,400.80
|
| Rate for Payer: Coventry All Commercial |
$14,572.80
|
| Rate for Payer: Encore All Commercial |
$15,243.48
|
| Rate for Payer: Frontpath All Commercial |
$15,235.20
|
| Rate for Payer: Humana ChoiceCare |
$14,302.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,904.00
|
| Rate for Payer: PHCS All Commercial |
$12,420.00
|
| Rate for Payer: PHP All Commercial |
$12,559.10
|
| Rate for Payer: Sagamore Health Network All Products |
$12,784.32
|
| Rate for Payer: Signature Care EPO |
$13,744.80
|
| Rate for Payer: Signature Care PPO |
$14,572.80
|
| Rate for Payer: United Healthcare Commercial |
$13,049.28
|
|
