|
HC ZINC, RBC
|
Facility
|
OP
|
$153.67
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
63001719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$142.91 |
| Rate for Payer: Aetna Commercial |
$129.70
|
| Rate for Payer: Aetna Medicare |
$49.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$11.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.09
|
| Rate for Payer: Cash Price |
$92.20
|
| Rate for Payer: Cash Price |
$92.20
|
| Rate for Payer: Centivo All Commercial |
$83.60
|
| Rate for Payer: Cigna All Commercial |
$132.62
|
| Rate for Payer: CORVEL All Commercial |
$142.91
|
| Rate for Payer: Coventry All Commercial |
$135.23
|
| Rate for Payer: Encore All Commercial |
$141.45
|
| Rate for Payer: Frontpath All Commercial |
$141.38
|
| Rate for Payer: Humana ChoiceCare |
$132.72
|
| Rate for Payer: Humana Medicare |
$49.17
|
| Rate for Payer: Lucent All Commercial |
$83.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.30
|
| Rate for Payer: Managed Health Services Medicaid |
$11.39
|
| Rate for Payer: MDWise Medicaid |
$11.39
|
| Rate for Payer: PHCS All Commercial |
$115.25
|
| Rate for Payer: PHP All Commercial |
$116.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.93
|
| Rate for Payer: Sagamore Health Network All Products |
$118.63
|
| Rate for Payer: Signature Care EPO |
$127.55
|
| Rate for Payer: Signature Care PPO |
$135.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.62
|
| Rate for Payer: United Healthcare Commercial |
$121.09
|
| Rate for Payer: United Healthcare Medicare |
$49.17
|
|
|
HC Z INTRAMED PLUG LGE
|
Facility
|
IP
|
$772.80
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.60 |
| Max. Negotiated Rate |
$718.70 |
| Rate for Payer: Aetna Commercial |
$667.70
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cigna All Commercial |
$666.93
|
| Rate for Payer: CORVEL All Commercial |
$718.70
|
| Rate for Payer: Coventry All Commercial |
$680.06
|
| Rate for Payer: Encore All Commercial |
$711.36
|
| Rate for Payer: Frontpath All Commercial |
$710.98
|
| Rate for Payer: Humana ChoiceCare |
$667.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.52
|
| Rate for Payer: PHCS All Commercial |
$579.60
|
| Rate for Payer: PHP All Commercial |
$586.09
|
| Rate for Payer: Sagamore Health Network All Products |
$596.60
|
| Rate for Payer: Signature Care EPO |
$641.42
|
| Rate for Payer: Signature Care PPO |
$680.06
|
| Rate for Payer: United Healthcare Commercial |
$608.97
|
|
|
HC Z INTRAMED PLUG LGE
|
Facility
|
OP
|
$772.80
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$718.70 |
| Rate for Payer: Aetna Commercial |
$652.24
|
| Rate for Payer: Aetna Medicare |
$247.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$443.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$483.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$284.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$272.03
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Centivo All Commercial |
$420.40
|
| Rate for Payer: Cigna All Commercial |
$666.93
|
| Rate for Payer: CORVEL All Commercial |
$718.70
|
| Rate for Payer: Coventry All Commercial |
$680.06
|
| Rate for Payer: Encore All Commercial |
$711.36
|
| Rate for Payer: Frontpath All Commercial |
$710.98
|
| Rate for Payer: Humana ChoiceCare |
$667.47
|
| Rate for Payer: Humana Medicare |
$247.30
|
| Rate for Payer: Lucent All Commercial |
$420.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.52
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$579.60
|
| Rate for Payer: PHP All Commercial |
$586.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$301.39
|
| Rate for Payer: Sagamore Health Network All Products |
$596.60
|
| Rate for Payer: Signature Care EPO |
$641.42
|
| Rate for Payer: Signature Care PPO |
$680.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$656.88
|
| Rate for Payer: United Healthcare Commercial |
$608.97
|
| Rate for Payer: United Healthcare Medicare |
$247.30
|
|
|
HC ZIO XT 3-7 DAYS
|
Facility
|
OP
|
$381.89
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
1503242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$355.16 |
| Rate for Payer: Aetna Commercial |
$322.32
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$118.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$219.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.43
|
| Rate for Payer: Cash Price |
$229.13
|
| Rate for Payer: Cash Price |
$229.13
|
| Rate for Payer: Centivo All Commercial |
$207.75
|
| Rate for Payer: Cigna All Commercial |
$329.57
|
| Rate for Payer: CORVEL All Commercial |
$355.16
|
| Rate for Payer: Coventry All Commercial |
$336.06
|
| Rate for Payer: Encore All Commercial |
$351.53
|
| Rate for Payer: Frontpath All Commercial |
$351.34
|
| Rate for Payer: Humana ChoiceCare |
$329.84
|
| Rate for Payer: Humana Medicare |
$122.20
|
| Rate for Payer: Lucent All Commercial |
$207.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.70
|
| Rate for Payer: Managed Health Services Medicaid |
$34.97
|
| Rate for Payer: MDWise Medicaid |
$34.97
|
| Rate for Payer: PHCS All Commercial |
$286.42
|
| Rate for Payer: PHP All Commercial |
$289.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.94
|
| Rate for Payer: Sagamore Health Network All Products |
$294.82
|
| Rate for Payer: Signature Care EPO |
$316.97
|
| Rate for Payer: Signature Care PPO |
$336.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$324.61
|
| Rate for Payer: United Healthcare Commercial |
$300.93
|
| Rate for Payer: United Healthcare Medicare |
$122.20
|
|
|
HC ZIO XT 3-7 DAYS
|
Facility
|
IP
|
$381.89
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
1503242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$286.42 |
| Max. Negotiated Rate |
$355.16 |
| Rate for Payer: Aetna Commercial |
$329.95
|
| Rate for Payer: Cash Price |
$229.13
|
| Rate for Payer: Cigna All Commercial |
$329.57
|
| Rate for Payer: CORVEL All Commercial |
$355.16
|
| Rate for Payer: Coventry All Commercial |
$336.06
|
| Rate for Payer: Encore All Commercial |
$351.53
|
| Rate for Payer: Frontpath All Commercial |
$351.34
|
| Rate for Payer: Humana ChoiceCare |
$329.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.70
|
| Rate for Payer: PHCS All Commercial |
$286.42
|
| Rate for Payer: PHP All Commercial |
$289.63
|
| Rate for Payer: Sagamore Health Network All Products |
$294.82
|
| Rate for Payer: Signature Care EPO |
$316.97
|
| Rate for Payer: Signature Care PPO |
$336.06
|
| Rate for Payer: United Healthcare Commercial |
$300.93
|
|
|
HC ZIO XT 7-15 DAYS
|
Facility
|
IP
|
$521.65
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
1503246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$391.24 |
| Max. Negotiated Rate |
$485.13 |
| Rate for Payer: Aetna Commercial |
$450.71
|
| Rate for Payer: Cash Price |
$312.99
|
| Rate for Payer: Cigna All Commercial |
$450.18
|
| Rate for Payer: CORVEL All Commercial |
$485.13
|
| Rate for Payer: Coventry All Commercial |
$459.05
|
| Rate for Payer: Encore All Commercial |
$480.18
|
| Rate for Payer: Frontpath All Commercial |
$479.92
|
| Rate for Payer: Humana ChoiceCare |
$450.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$469.49
|
| Rate for Payer: PHCS All Commercial |
$391.24
|
| Rate for Payer: PHP All Commercial |
$395.62
|
| Rate for Payer: Sagamore Health Network All Products |
$402.71
|
| Rate for Payer: Signature Care EPO |
$432.97
|
| Rate for Payer: Signature Care PPO |
$459.05
|
| Rate for Payer: United Healthcare Commercial |
$411.06
|
|
|
HC ZIO XT 7-15 DAYS
|
Facility
|
OP
|
$521.65
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
1503246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$485.13 |
| Rate for Payer: Aetna Commercial |
$440.27
|
| Rate for Payer: Aetna Medicare |
$166.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$299.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$326.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.62
|
| Rate for Payer: Cash Price |
$312.99
|
| Rate for Payer: Cash Price |
$312.99
|
| Rate for Payer: Centivo All Commercial |
$283.78
|
| Rate for Payer: Cigna All Commercial |
$450.18
|
| Rate for Payer: CORVEL All Commercial |
$485.13
|
| Rate for Payer: Coventry All Commercial |
$459.05
|
| Rate for Payer: Encore All Commercial |
$480.18
|
| Rate for Payer: Frontpath All Commercial |
$479.92
|
| Rate for Payer: Humana ChoiceCare |
$450.55
|
| Rate for Payer: Humana Medicare |
$166.93
|
| Rate for Payer: Lucent All Commercial |
$283.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$469.49
|
| Rate for Payer: Managed Health Services Medicaid |
$34.97
|
| Rate for Payer: MDWise Medicaid |
$34.97
|
| Rate for Payer: PHCS All Commercial |
$391.24
|
| Rate for Payer: PHP All Commercial |
$395.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$203.44
|
| Rate for Payer: Sagamore Health Network All Products |
$402.71
|
| Rate for Payer: Signature Care EPO |
$432.97
|
| Rate for Payer: Signature Care PPO |
$459.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$443.40
|
| Rate for Payer: United Healthcare Commercial |
$411.06
|
| Rate for Payer: United Healthcare Medicare |
$166.93
|
|
|
HC ZIP 24 SKIN CLOSURE
|
Facility
|
OP
|
$2,515.07
|
|
| Hospital Charge Code |
41608491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,339.02 |
| Rate for Payer: Aetna Commercial |
$2,122.72
|
| Rate for Payer: Aetna Medicare |
$804.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$779.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,444.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,572.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$925.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$885.30
|
| Rate for Payer: Cash Price |
$1,509.04
|
| Rate for Payer: Cash Price |
$1,509.04
|
| Rate for Payer: Centivo All Commercial |
$1,368.20
|
| Rate for Payer: Cigna All Commercial |
$2,170.51
|
| Rate for Payer: CORVEL All Commercial |
$2,339.02
|
| Rate for Payer: Coventry All Commercial |
$2,213.26
|
| Rate for Payer: Encore All Commercial |
$2,315.12
|
| Rate for Payer: Frontpath All Commercial |
$2,313.86
|
| Rate for Payer: Humana ChoiceCare |
$2,172.27
|
| Rate for Payer: Humana Medicare |
$804.82
|
| Rate for Payer: Lucent All Commercial |
$1,368.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,263.56
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,886.30
|
| Rate for Payer: PHP All Commercial |
$1,907.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$980.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,941.63
|
| Rate for Payer: Signature Care EPO |
$2,087.51
|
| Rate for Payer: Signature Care PPO |
$2,213.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,137.81
|
| Rate for Payer: United Healthcare Commercial |
$1,981.88
|
| Rate for Payer: United Healthcare Medicare |
$804.82
|
|
|
HC ZIP 24 SKIN CLOSURE
|
Facility
|
IP
|
$2,515.07
|
|
| Hospital Charge Code |
41608491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,886.30 |
| Max. Negotiated Rate |
$2,339.02 |
| Rate for Payer: Aetna Commercial |
$2,173.02
|
| Rate for Payer: Cash Price |
$1,509.04
|
| Rate for Payer: Cigna All Commercial |
$2,170.51
|
| Rate for Payer: CORVEL All Commercial |
$2,339.02
|
| Rate for Payer: Coventry All Commercial |
$2,213.26
|
| Rate for Payer: Encore All Commercial |
$2,315.12
|
| Rate for Payer: Frontpath All Commercial |
$2,313.86
|
| Rate for Payer: Humana ChoiceCare |
$2,172.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,263.56
|
| Rate for Payer: PHCS All Commercial |
$1,886.30
|
| Rate for Payer: PHP All Commercial |
$1,907.43
|
| Rate for Payer: Sagamore Health Network All Products |
$1,941.63
|
| Rate for Payer: Signature Care EPO |
$2,087.51
|
| Rate for Payer: Signature Care PPO |
$2,213.26
|
| Rate for Payer: United Healthcare Commercial |
$1,981.88
|
|
|
HC Z JGRLOC TITANIUM KIT
|
Facility
|
OP
|
$4,687.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,359.10 |
| Rate for Payer: Aetna Commercial |
$3,956.00
|
| Rate for Payer: Aetna Medicare |
$1,499.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,453.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,691.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,929.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,724.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,649.89
|
| Rate for Payer: Cash Price |
$2,812.32
|
| Rate for Payer: Cash Price |
$2,812.32
|
| Rate for Payer: Centivo All Commercial |
$2,549.84
|
| Rate for Payer: Cigna All Commercial |
$4,045.05
|
| Rate for Payer: CORVEL All Commercial |
$4,359.10
|
| Rate for Payer: Coventry All Commercial |
$4,124.74
|
| Rate for Payer: Encore All Commercial |
$4,314.57
|
| Rate for Payer: Frontpath All Commercial |
$4,312.22
|
| Rate for Payer: Humana ChoiceCare |
$4,048.33
|
| Rate for Payer: Humana Medicare |
$1,499.90
|
| Rate for Payer: Lucent All Commercial |
$2,549.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,218.48
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,515.40
|
| Rate for Payer: PHP All Commercial |
$3,554.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,828.01
|
| Rate for Payer: Sagamore Health Network All Products |
$3,618.52
|
| Rate for Payer: Signature Care EPO |
$3,890.38
|
| Rate for Payer: Signature Care PPO |
$4,124.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,984.12
|
| Rate for Payer: United Healthcare Commercial |
$3,693.51
|
| Rate for Payer: United Healthcare Medicare |
$1,499.90
|
|
|
HC Z JGRLOC TITANIUM KIT
|
Facility
|
IP
|
$4,687.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.40 |
| Max. Negotiated Rate |
$4,359.10 |
| Rate for Payer: Aetna Commercial |
$4,049.74
|
| Rate for Payer: Cash Price |
$2,812.32
|
| Rate for Payer: Cigna All Commercial |
$4,045.05
|
| Rate for Payer: CORVEL All Commercial |
$4,359.10
|
| Rate for Payer: Coventry All Commercial |
$4,124.74
|
| Rate for Payer: Encore All Commercial |
$4,314.57
|
| Rate for Payer: Frontpath All Commercial |
$4,312.22
|
| Rate for Payer: Humana ChoiceCare |
$4,048.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,218.48
|
| Rate for Payer: PHCS All Commercial |
$3,515.40
|
| Rate for Payer: PHP All Commercial |
$3,554.77
|
| Rate for Payer: Sagamore Health Network All Products |
$3,618.52
|
| Rate for Payer: Signature Care EPO |
$3,890.38
|
| Rate for Payer: Signature Care PPO |
$4,124.74
|
| Rate for Payer: United Healthcare Commercial |
$3,693.51
|
|
|
HC Z JUGSTITCH 2-0 SZ 5 772
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.50 |
| Max. Negotiated Rate |
$1,887.90 |
| Rate for Payer: Aetna Commercial |
$1,753.92
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna All Commercial |
$1,751.89
|
| Rate for Payer: CORVEL All Commercial |
$1,887.90
|
| Rate for Payer: Coventry All Commercial |
$1,786.40
|
| Rate for Payer: Encore All Commercial |
$1,868.62
|
| Rate for Payer: Frontpath All Commercial |
$1,867.60
|
| Rate for Payer: Humana ChoiceCare |
$1,753.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,827.00
|
| Rate for Payer: PHCS All Commercial |
$1,522.50
|
| Rate for Payer: PHP All Commercial |
$1,539.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,567.16
|
| Rate for Payer: Signature Care EPO |
$1,684.90
|
| Rate for Payer: Signature Care PPO |
$1,786.40
|
| Rate for Payer: United Healthcare Commercial |
$1,599.64
|
|
|
HC Z JUGSTITCH 2-0 SZ 5 772
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,887.90 |
| Rate for Payer: Aetna Commercial |
$1,713.32
|
| Rate for Payer: Aetna Medicare |
$649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$629.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,165.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,268.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$747.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$714.56
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Centivo All Commercial |
$1,104.32
|
| Rate for Payer: Cigna All Commercial |
$1,751.89
|
| Rate for Payer: CORVEL All Commercial |
$1,887.90
|
| Rate for Payer: Coventry All Commercial |
$1,786.40
|
| Rate for Payer: Encore All Commercial |
$1,868.62
|
| Rate for Payer: Frontpath All Commercial |
$1,867.60
|
| Rate for Payer: Humana ChoiceCare |
$1,753.31
|
| Rate for Payer: Humana Medicare |
$649.60
|
| Rate for Payer: Lucent All Commercial |
$1,104.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,827.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,522.50
|
| Rate for Payer: PHP All Commercial |
$1,539.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$791.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,567.16
|
| Rate for Payer: Signature Care EPO |
$1,684.90
|
| Rate for Payer: Signature Care PPO |
$1,786.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,725.50
|
| Rate for Payer: United Healthcare Commercial |
$1,599.64
|
| Rate for Payer: United Healthcare Medicare |
$649.60
|
|
|
HC Z JUGSTITCH 2-0 SZ 5 773
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.50 |
| Max. Negotiated Rate |
$1,887.90 |
| Rate for Payer: Aetna Commercial |
$1,753.92
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna All Commercial |
$1,751.89
|
| Rate for Payer: CORVEL All Commercial |
$1,887.90
|
| Rate for Payer: Coventry All Commercial |
$1,786.40
|
| Rate for Payer: Encore All Commercial |
$1,868.62
|
| Rate for Payer: Frontpath All Commercial |
$1,867.60
|
| Rate for Payer: Humana ChoiceCare |
$1,753.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,827.00
|
| Rate for Payer: PHCS All Commercial |
$1,522.50
|
| Rate for Payer: PHP All Commercial |
$1,539.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1,567.16
|
| Rate for Payer: Signature Care EPO |
$1,684.90
|
| Rate for Payer: Signature Care PPO |
$1,786.40
|
| Rate for Payer: United Healthcare Commercial |
$1,599.64
|
|
|
HC Z JUGSTITCH 2-0 SZ 5 773
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,887.90 |
| Rate for Payer: Aetna Commercial |
$1,713.32
|
| Rate for Payer: Aetna Medicare |
$649.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$629.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,165.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,268.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$747.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$714.56
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Centivo All Commercial |
$1,104.32
|
| Rate for Payer: Cigna All Commercial |
$1,751.89
|
| Rate for Payer: CORVEL All Commercial |
$1,887.90
|
| Rate for Payer: Coventry All Commercial |
$1,786.40
|
| Rate for Payer: Encore All Commercial |
$1,868.62
|
| Rate for Payer: Frontpath All Commercial |
$1,867.60
|
| Rate for Payer: Humana ChoiceCare |
$1,753.31
|
| Rate for Payer: Humana Medicare |
$649.60
|
| Rate for Payer: Lucent All Commercial |
$1,104.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,827.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,522.50
|
| Rate for Payer: PHP All Commercial |
$1,539.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$791.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,567.16
|
| Rate for Payer: Signature Care EPO |
$1,684.90
|
| Rate for Payer: Signature Care PPO |
$1,786.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,725.50
|
| Rate for Payer: United Healthcare Commercial |
$1,599.64
|
| Rate for Payer: United Healthcare Medicare |
$649.60
|
|
|
HC Z JUGSTITCH 2-0 SZ 5 773N
|
Facility
|
OP
|
$1,942.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,806.53 |
| Rate for Payer: Aetna Commercial |
$1,639.47
|
| Rate for Payer: Aetna Medicare |
$621.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$602.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,115.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,214.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$714.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$683.76
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Centivo All Commercial |
$1,056.72
|
| Rate for Payer: Cigna All Commercial |
$1,676.38
|
| Rate for Payer: CORVEL All Commercial |
$1,806.53
|
| Rate for Payer: Coventry All Commercial |
$1,709.40
|
| Rate for Payer: Encore All Commercial |
$1,788.07
|
| Rate for Payer: Frontpath All Commercial |
$1,787.10
|
| Rate for Payer: Humana ChoiceCare |
$1,677.74
|
| Rate for Payer: Humana Medicare |
$621.60
|
| Rate for Payer: Lucent All Commercial |
$1,056.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,748.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,456.88
|
| Rate for Payer: PHP All Commercial |
$1,473.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$757.58
|
| Rate for Payer: Sagamore Health Network All Products |
$1,499.61
|
| Rate for Payer: Signature Care EPO |
$1,612.28
|
| Rate for Payer: Signature Care PPO |
$1,709.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,651.12
|
| Rate for Payer: United Healthcare Commercial |
$1,530.69
|
| Rate for Payer: United Healthcare Medicare |
$621.60
|
|
|
HC Z JUGSTITCH 2-0 SZ 5 773N
|
Facility
|
IP
|
$1,942.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.88 |
| Max. Negotiated Rate |
$1,806.53 |
| Rate for Payer: Aetna Commercial |
$1,678.32
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cigna All Commercial |
$1,676.38
|
| Rate for Payer: CORVEL All Commercial |
$1,806.53
|
| Rate for Payer: Coventry All Commercial |
$1,709.40
|
| Rate for Payer: Encore All Commercial |
$1,788.07
|
| Rate for Payer: Frontpath All Commercial |
$1,787.10
|
| Rate for Payer: Humana ChoiceCare |
$1,677.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,748.25
|
| Rate for Payer: PHCS All Commercial |
$1,456.88
|
| Rate for Payer: PHP All Commercial |
$1,473.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,499.61
|
| Rate for Payer: Signature Care EPO |
$1,612.28
|
| Rate for Payer: Signature Care PPO |
$1,709.40
|
| Rate for Payer: United Healthcare Commercial |
$1,530.69
|
|
|
HC Z JUGSTITCH HALFPIPE CANNULA
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$804.38
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
|
|
HC Z JUGSTITCH HALFPIPE CANNULA
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$865.83 |
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$297.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$288.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$534.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$342.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$327.71
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Centivo All Commercial |
$506.46
|
| Rate for Payer: Cigna All Commercial |
$803.45
|
| Rate for Payer: CORVEL All Commercial |
$865.83
|
| Rate for Payer: Coventry All Commercial |
$819.28
|
| Rate for Payer: Encore All Commercial |
$856.99
|
| Rate for Payer: Frontpath All Commercial |
$856.52
|
| Rate for Payer: Humana ChoiceCare |
$804.10
|
| Rate for Payer: Humana Medicare |
$297.92
|
| Rate for Payer: Lucent All Commercial |
$506.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.90
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$698.25
|
| Rate for Payer: PHP All Commercial |
$706.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.09
|
| Rate for Payer: Sagamore Health Network All Products |
$718.73
|
| Rate for Payer: Signature Care EPO |
$772.73
|
| Rate for Payer: Signature Care PPO |
$819.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$791.35
|
| Rate for Payer: United Healthcare Commercial |
$733.63
|
| Rate for Payer: United Healthcare Medicare |
$297.92
|
|
|
HC Z JUGSTITCH SUTURE CUTTER
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,106.70 |
| Rate for Payer: Aetna Commercial |
$1,004.36
|
| Rate for Payer: Aetna Medicare |
$380.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$368.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$683.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$743.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$437.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$418.88
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Centivo All Commercial |
$647.36
|
| Rate for Payer: Cigna All Commercial |
$1,026.97
|
| Rate for Payer: CORVEL All Commercial |
$1,106.70
|
| Rate for Payer: Coventry All Commercial |
$1,047.20
|
| Rate for Payer: Encore All Commercial |
$1,095.39
|
| Rate for Payer: Frontpath All Commercial |
$1,094.80
|
| Rate for Payer: Humana ChoiceCare |
$1,027.80
|
| Rate for Payer: Humana Medicare |
$380.80
|
| Rate for Payer: Lucent All Commercial |
$647.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,071.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$892.50
|
| Rate for Payer: PHP All Commercial |
$902.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$464.10
|
| Rate for Payer: Sagamore Health Network All Products |
$918.68
|
| Rate for Payer: Signature Care EPO |
$987.70
|
| Rate for Payer: Signature Care PPO |
$1,047.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,011.50
|
| Rate for Payer: United Healthcare Commercial |
$937.72
|
| Rate for Payer: United Healthcare Medicare |
$380.80
|
|
|
HC Z JUGSTITCH SUTURE CUTTER
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$1,106.70 |
| Rate for Payer: Aetna Commercial |
$1,028.16
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna All Commercial |
$1,026.97
|
| Rate for Payer: CORVEL All Commercial |
$1,106.70
|
| Rate for Payer: Coventry All Commercial |
$1,047.20
|
| Rate for Payer: Encore All Commercial |
$1,095.39
|
| Rate for Payer: Frontpath All Commercial |
$1,094.80
|
| Rate for Payer: Humana ChoiceCare |
$1,027.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,071.00
|
| Rate for Payer: PHCS All Commercial |
$892.50
|
| Rate for Payer: PHP All Commercial |
$902.50
|
| Rate for Payer: Sagamore Health Network All Products |
$918.68
|
| Rate for Payer: Signature Care EPO |
$987.70
|
| Rate for Payer: Signature Care PPO |
$1,047.20
|
| Rate for Payer: United Healthcare Commercial |
$937.72
|
|
|
HC Z KIT FEM CEMENT PREP
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$807.24 |
| Rate for Payer: Aetna Commercial |
$732.59
|
| Rate for Payer: Aetna Medicare |
$277.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$498.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$542.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$319.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$305.54
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Centivo All Commercial |
$472.19
|
| Rate for Payer: Cigna All Commercial |
$749.08
|
| Rate for Payer: CORVEL All Commercial |
$807.24
|
| Rate for Payer: Coventry All Commercial |
$763.84
|
| Rate for Payer: Encore All Commercial |
$798.99
|
| Rate for Payer: Frontpath All Commercial |
$798.56
|
| Rate for Payer: Humana ChoiceCare |
$749.69
|
| Rate for Payer: Humana Medicare |
$277.76
|
| Rate for Payer: Lucent All Commercial |
$472.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$781.20
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$651.00
|
| Rate for Payer: PHP All Commercial |
$658.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$338.52
|
| Rate for Payer: Sagamore Health Network All Products |
$670.10
|
| Rate for Payer: Signature Care EPO |
$720.44
|
| Rate for Payer: Signature Care PPO |
$763.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$737.80
|
| Rate for Payer: United Healthcare Commercial |
$683.98
|
| Rate for Payer: United Healthcare Medicare |
$277.76
|
|
|
HC Z KIT FEM CEMENT PREP
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.00 |
| Max. Negotiated Rate |
$807.24 |
| Rate for Payer: Aetna Commercial |
$749.95
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna All Commercial |
$749.08
|
| Rate for Payer: CORVEL All Commercial |
$807.24
|
| Rate for Payer: Coventry All Commercial |
$763.84
|
| Rate for Payer: Encore All Commercial |
$798.99
|
| Rate for Payer: Frontpath All Commercial |
$798.56
|
| Rate for Payer: Humana ChoiceCare |
$749.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$781.20
|
| Rate for Payer: PHCS All Commercial |
$651.00
|
| Rate for Payer: PHP All Commercial |
$658.29
|
| Rate for Payer: Sagamore Health Network All Products |
$670.10
|
| Rate for Payer: Signature Care EPO |
$720.44
|
| Rate for Payer: Signature Care PPO |
$763.84
|
| Rate for Payer: United Healthcare Commercial |
$683.98
|
|
|
HC Z K-WIRE .045 4IN TROC TIP
|
Facility
|
OP
|
$301.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.55 |
| Max. Negotiated Rate |
$280.65 |
| Rate for Payer: Aetna Commercial |
$254.69
|
| Rate for Payer: Aetna Medicare |
$96.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$173.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$188.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.22
|
| Rate for Payer: Cash Price |
$181.06
|
| Rate for Payer: Cash Price |
$181.06
|
| Rate for Payer: Centivo All Commercial |
$164.16
|
| Rate for Payer: Cigna All Commercial |
$260.43
|
| Rate for Payer: CORVEL All Commercial |
$280.65
|
| Rate for Payer: Coventry All Commercial |
$265.56
|
| Rate for Payer: Encore All Commercial |
$277.78
|
| Rate for Payer: Frontpath All Commercial |
$277.63
|
| Rate for Payer: Humana ChoiceCare |
$260.64
|
| Rate for Payer: Humana Medicare |
$96.57
|
| Rate for Payer: Lucent All Commercial |
$164.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$271.59
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$226.33
|
| Rate for Payer: PHP All Commercial |
$228.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.69
|
| Rate for Payer: Sagamore Health Network All Products |
$232.97
|
| Rate for Payer: Signature Care EPO |
$250.47
|
| Rate for Payer: Signature Care PPO |
$265.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$256.50
|
| Rate for Payer: United Healthcare Commercial |
$237.79
|
| Rate for Payer: United Healthcare Medicare |
$96.57
|
|
|
HC Z K-WIRE .045 4IN TROC TIP
|
Facility
|
IP
|
$301.77
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.33 |
| Max. Negotiated Rate |
$280.65 |
| Rate for Payer: Aetna Commercial |
$260.73
|
| Rate for Payer: Cash Price |
$181.06
|
| Rate for Payer: Cigna All Commercial |
$260.43
|
| Rate for Payer: CORVEL All Commercial |
$280.65
|
| Rate for Payer: Coventry All Commercial |
$265.56
|
| Rate for Payer: Encore All Commercial |
$277.78
|
| Rate for Payer: Frontpath All Commercial |
$277.63
|
| Rate for Payer: Humana ChoiceCare |
$260.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$271.59
|
| Rate for Payer: PHCS All Commercial |
$226.33
|
| Rate for Payer: PHP All Commercial |
$228.86
|
| Rate for Payer: Sagamore Health Network All Products |
$232.97
|
| Rate for Payer: Signature Care EPO |
$250.47
|
| Rate for Payer: Signature Care PPO |
$265.56
|
| Rate for Payer: United Healthcare Commercial |
$237.79
|
|
