|
HC Z VERSA TI STD TAPER
|
Facility
|
OP
|
$986.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$917.63 |
| Rate for Payer: Aetna Commercial |
$832.77
|
| Rate for Payer: Aetna Medicare |
$315.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$305.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$566.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$363.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$347.32
|
| Rate for Payer: Cash Price |
$592.02
|
| Rate for Payer: Cash Price |
$592.02
|
| Rate for Payer: Centivo All Commercial |
$536.76
|
| Rate for Payer: Cigna All Commercial |
$851.52
|
| Rate for Payer: CORVEL All Commercial |
$917.63
|
| Rate for Payer: Coventry All Commercial |
$868.30
|
| Rate for Payer: Encore All Commercial |
$908.26
|
| Rate for Payer: Frontpath All Commercial |
$907.76
|
| Rate for Payer: Humana ChoiceCare |
$852.21
|
| Rate for Payer: Humana Medicare |
$315.74
|
| Rate for Payer: Lucent All Commercial |
$536.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$888.03
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$740.02
|
| Rate for Payer: PHP All Commercial |
$748.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$384.81
|
| Rate for Payer: Sagamore Health Network All Products |
$761.73
|
| Rate for Payer: Signature Care EPO |
$818.96
|
| Rate for Payer: Signature Care PPO |
$868.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$838.70
|
| Rate for Payer: United Healthcare Commercial |
$777.52
|
| Rate for Payer: United Healthcare Medicare |
$315.74
|
|
|
HC Z VERSA TI STD TAPER
|
Facility
|
IP
|
$986.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.02 |
| Max. Negotiated Rate |
$917.63 |
| Rate for Payer: Aetna Commercial |
$852.51
|
| Rate for Payer: Cash Price |
$592.02
|
| Rate for Payer: Cigna All Commercial |
$851.52
|
| Rate for Payer: CORVEL All Commercial |
$917.63
|
| Rate for Payer: Coventry All Commercial |
$868.30
|
| Rate for Payer: Encore All Commercial |
$908.26
|
| Rate for Payer: Frontpath All Commercial |
$907.76
|
| Rate for Payer: Humana ChoiceCare |
$852.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$888.03
|
| Rate for Payer: PHCS All Commercial |
$740.02
|
| Rate for Payer: PHP All Commercial |
$748.31
|
| Rate for Payer: Sagamore Health Network All Products |
$761.73
|
| Rate for Payer: Signature Care EPO |
$818.96
|
| Rate for Payer: Signature Care PPO |
$868.30
|
| Rate for Payer: United Healthcare Commercial |
$777.52
|
|
|
HC Z WASHER 2.7 3.5 4.0
|
Facility
|
OP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Aetna Medicare |
$47.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.51
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Centivo All Commercial |
$81.15
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Lucent All Commercial |
$81.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.18
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.79
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
|
|
HC Z WASHER 2.7 3.5 4.0
|
Facility
|
IP
|
$149.17
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$138.73 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna All Commercial |
$128.73
|
| Rate for Payer: CORVEL All Commercial |
$138.73
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Encore All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.24
|
| Rate for Payer: Humana ChoiceCare |
$128.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.25
|
| Rate for Payer: PHCS All Commercial |
$111.88
|
| Rate for Payer: PHP All Commercial |
$113.13
|
| Rate for Payer: Sagamore Health Network All Products |
$115.16
|
| Rate for Payer: Signature Care EPO |
$123.81
|
| Rate for Payer: Signature Care PPO |
$131.27
|
| Rate for Payer: United Healthcare Commercial |
$117.55
|
|
|
HC Z WASHER 3.5 4.0
|
Facility
|
IP
|
$261.03
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.77 |
| Max. Negotiated Rate |
$242.76 |
| Rate for Payer: Aetna Commercial |
$225.53
|
| Rate for Payer: Cash Price |
$156.62
|
| Rate for Payer: Cigna All Commercial |
$225.27
|
| Rate for Payer: CORVEL All Commercial |
$242.76
|
| Rate for Payer: Coventry All Commercial |
$229.71
|
| Rate for Payer: Encore All Commercial |
$240.28
|
| Rate for Payer: Frontpath All Commercial |
$240.15
|
| Rate for Payer: Humana ChoiceCare |
$225.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.93
|
| Rate for Payer: PHCS All Commercial |
$195.77
|
| Rate for Payer: PHP All Commercial |
$197.97
|
| Rate for Payer: Sagamore Health Network All Products |
$201.52
|
| Rate for Payer: Signature Care EPO |
$216.65
|
| Rate for Payer: Signature Care PPO |
$229.71
|
| Rate for Payer: United Healthcare Commercial |
$205.69
|
|
|
HC Z WASHER 3.5 4.0
|
Facility
|
OP
|
$261.03
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$242.76 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: Aetna Medicare |
$83.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$149.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$163.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.88
|
| Rate for Payer: Cash Price |
$156.62
|
| Rate for Payer: Cash Price |
$156.62
|
| Rate for Payer: Centivo All Commercial |
$142.00
|
| Rate for Payer: Cigna All Commercial |
$225.27
|
| Rate for Payer: CORVEL All Commercial |
$242.76
|
| Rate for Payer: Coventry All Commercial |
$229.71
|
| Rate for Payer: Encore All Commercial |
$240.28
|
| Rate for Payer: Frontpath All Commercial |
$240.15
|
| Rate for Payer: Humana ChoiceCare |
$225.45
|
| Rate for Payer: Humana Medicare |
$83.53
|
| Rate for Payer: Lucent All Commercial |
$142.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.93
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$195.77
|
| Rate for Payer: PHP All Commercial |
$197.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.80
|
| Rate for Payer: Sagamore Health Network All Products |
$201.52
|
| Rate for Payer: Signature Care EPO |
$216.65
|
| Rate for Payer: Signature Care PPO |
$229.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.88
|
| Rate for Payer: United Healthcare Commercial |
$205.69
|
| Rate for Payer: United Healthcare Medicare |
$83.53
|
|
|
HC Z WASHER 5.5 6.0 6.5 7
|
Facility
|
OP
|
$261.03
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$242.76 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: Aetna Medicare |
$83.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$149.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$163.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.88
|
| Rate for Payer: Cash Price |
$156.62
|
| Rate for Payer: Cash Price |
$156.62
|
| Rate for Payer: Centivo All Commercial |
$142.00
|
| Rate for Payer: Cigna All Commercial |
$225.27
|
| Rate for Payer: CORVEL All Commercial |
$242.76
|
| Rate for Payer: Coventry All Commercial |
$229.71
|
| Rate for Payer: Encore All Commercial |
$240.28
|
| Rate for Payer: Frontpath All Commercial |
$240.15
|
| Rate for Payer: Humana ChoiceCare |
$225.45
|
| Rate for Payer: Humana Medicare |
$83.53
|
| Rate for Payer: Lucent All Commercial |
$142.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.93
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$195.77
|
| Rate for Payer: PHP All Commercial |
$197.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.80
|
| Rate for Payer: Sagamore Health Network All Products |
$201.52
|
| Rate for Payer: Signature Care EPO |
$216.65
|
| Rate for Payer: Signature Care PPO |
$229.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$221.88
|
| Rate for Payer: United Healthcare Commercial |
$205.69
|
| Rate for Payer: United Healthcare Medicare |
$83.53
|
|
|
HC Z WASHER 5.5 6.0 6.5 7
|
Facility
|
IP
|
$261.03
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.77 |
| Max. Negotiated Rate |
$242.76 |
| Rate for Payer: Aetna Commercial |
$225.53
|
| Rate for Payer: Cash Price |
$156.62
|
| Rate for Payer: Cigna All Commercial |
$225.27
|
| Rate for Payer: CORVEL All Commercial |
$242.76
|
| Rate for Payer: Coventry All Commercial |
$229.71
|
| Rate for Payer: Encore All Commercial |
$240.28
|
| Rate for Payer: Frontpath All Commercial |
$240.15
|
| Rate for Payer: Humana ChoiceCare |
$225.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.93
|
| Rate for Payer: PHCS All Commercial |
$195.77
|
| Rate for Payer: PHP All Commercial |
$197.97
|
| Rate for Payer: Sagamore Health Network All Products |
$201.52
|
| Rate for Payer: Signature Care EPO |
$216.65
|
| Rate for Payer: Signature Care PPO |
$229.71
|
| Rate for Payer: United Healthcare Commercial |
$205.69
|
|
|
HC Z WASHER 6.5 3PK
|
Facility
|
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$210.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.44
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Centivo All Commercial |
$357.69
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$210.40
|
| Rate for Payer: Lucent All Commercial |
$357.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$210.40
|
|
|
HC Z WASHER 6.5 3PK
|
Facility
|
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z WASHER CUP3.5/4.0
|
Facility
|
OP
|
$855.47
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$795.59 |
| Rate for Payer: Aetna Commercial |
$722.02
|
| Rate for Payer: Aetna Medicare |
$273.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$265.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$491.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$534.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$314.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.13
|
| Rate for Payer: Cash Price |
$513.28
|
| Rate for Payer: Cash Price |
$513.28
|
| Rate for Payer: Centivo All Commercial |
$465.38
|
| Rate for Payer: Cigna All Commercial |
$738.27
|
| Rate for Payer: CORVEL All Commercial |
$795.59
|
| Rate for Payer: Coventry All Commercial |
$752.81
|
| Rate for Payer: Encore All Commercial |
$787.46
|
| Rate for Payer: Frontpath All Commercial |
$787.03
|
| Rate for Payer: Humana ChoiceCare |
$738.87
|
| Rate for Payer: Humana Medicare |
$273.75
|
| Rate for Payer: Lucent All Commercial |
$465.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$769.92
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$641.60
|
| Rate for Payer: PHP All Commercial |
$648.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$333.63
|
| Rate for Payer: Sagamore Health Network All Products |
$660.42
|
| Rate for Payer: Signature Care EPO |
$710.04
|
| Rate for Payer: Signature Care PPO |
$752.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$727.15
|
| Rate for Payer: United Healthcare Commercial |
$674.11
|
| Rate for Payer: United Healthcare Medicare |
$273.75
|
|
|
HC Z WASHER CUP3.5/4.0
|
Facility
|
IP
|
$855.47
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.60 |
| Max. Negotiated Rate |
$795.59 |
| Rate for Payer: Aetna Commercial |
$739.13
|
| Rate for Payer: Cash Price |
$513.28
|
| Rate for Payer: Cigna All Commercial |
$738.27
|
| Rate for Payer: CORVEL All Commercial |
$795.59
|
| Rate for Payer: Coventry All Commercial |
$752.81
|
| Rate for Payer: Encore All Commercial |
$787.46
|
| Rate for Payer: Frontpath All Commercial |
$787.03
|
| Rate for Payer: Humana ChoiceCare |
$738.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$769.92
|
| Rate for Payer: PHCS All Commercial |
$641.60
|
| Rate for Payer: PHP All Commercial |
$648.79
|
| Rate for Payer: Sagamore Health Network All Products |
$660.42
|
| Rate for Payer: Signature Care EPO |
$710.04
|
| Rate for Payer: Signature Care PPO |
$752.81
|
| Rate for Payer: United Healthcare Commercial |
$674.11
|
|
|
HC Z WASHER PLAIN 3PK
|
Facility
|
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z WASHER PLAIN 3PK
|
Facility
|
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$210.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.44
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Centivo All Commercial |
$357.69
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$210.40
|
| Rate for Payer: Lucent All Commercial |
$357.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$210.40
|
|
|
HC Z WASHLER FLAT 4.8/5.0
|
Facility
|
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$210.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.44
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Centivo All Commercial |
$357.69
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$210.40
|
| Rate for Payer: Lucent All Commercial |
$357.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$210.40
|
|
|
HC Z WASHLER FLAT 4.8/5.0
|
Facility
|
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$394.51
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HEPARIN (PORCINE) 1000 UNITS/ML INJ SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
HEPARIN (PORCINE) 1000 UNITS/ML INJ SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
HEPARIN (PORCINE) 25000 UNIT/500 ML IV SOLP
|
Facility
|
OP
|
$108.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$100.91 |
| Rate for Payer: Aetna Commercial |
$91.57
|
| Rate for Payer: Aetna Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$62.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.19
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Centivo All Commercial |
$59.02
|
| Rate for Payer: Cigna All Commercial |
$93.64
|
| Rate for Payer: CORVEL All Commercial |
$100.91
|
| Rate for Payer: Coventry All Commercial |
$95.48
|
| Rate for Payer: Encore All Commercial |
$99.87
|
| Rate for Payer: Frontpath All Commercial |
$99.82
|
| Rate for Payer: Humana ChoiceCare |
$93.71
|
| Rate for Payer: Humana Medicare |
$34.72
|
| Rate for Payer: Lucent All Commercial |
$59.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.65
|
| Rate for Payer: PHCS All Commercial |
$81.38
|
| Rate for Payer: PHP All Commercial |
$82.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.31
|
| Rate for Payer: Sagamore Health Network All Products |
$83.76
|
| Rate for Payer: Signature Care EPO |
$90.06
|
| Rate for Payer: Signature Care PPO |
$95.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.22
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Medicare |
$34.72
|
|
|
HEPARIN (PORCINE) 25000 UNIT/500 ML IV SOLP
|
Facility
|
IP
|
$108.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$81.38 |
| Max. Negotiated Rate |
$100.91 |
| Rate for Payer: Aetna Commercial |
$93.74
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna All Commercial |
$93.64
|
| Rate for Payer: CORVEL All Commercial |
$100.91
|
| Rate for Payer: Coventry All Commercial |
$95.48
|
| Rate for Payer: Encore All Commercial |
$99.87
|
| Rate for Payer: Frontpath All Commercial |
$99.82
|
| Rate for Payer: Humana ChoiceCare |
$93.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.65
|
| Rate for Payer: PHCS All Commercial |
$81.38
|
| Rate for Payer: PHP All Commercial |
$82.29
|
| Rate for Payer: Sagamore Health Network All Products |
$83.76
|
| Rate for Payer: Signature Care EPO |
$90.06
|
| Rate for Payer: Signature Care PPO |
$95.48
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML (1 ML) INJ CRTG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
120987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML (1 ML) INJ CRTG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
120987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$59.08
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$40.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.64
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Centivo All Commercial |
$38.08
|
| Rate for Payer: Cigna All Commercial |
$60.41
|
| Rate for Payer: CORVEL All Commercial |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$64.40
|
| Rate for Payer: Humana ChoiceCare |
$60.46
|
| Rate for Payer: Humana Medicare |
$22.40
|
| Rate for Payer: Lucent All Commercial |
$38.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$52.50
|
| Rate for Payer: PHP All Commercial |
$53.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.30
|
| Rate for Payer: Sagamore Health Network All Products |
$54.04
|
| Rate for Payer: Signature Care EPO |
$58.10
|
| Rate for Payer: Signature Care PPO |
$61.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$55.16
|
| Rate for Payer: United Healthcare Medicare |
$22.40
|
|
|
HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$60.48
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna All Commercial |
$60.41
|
| Rate for Payer: CORVEL All Commercial |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$61.60
|
| Rate for Payer: Encore All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$64.40
|
| Rate for Payer: Humana ChoiceCare |
$60.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$52.50
|
| Rate for Payer: PHP All Commercial |
$53.09
|
| Rate for Payer: Sagamore Health Network All Products |
$54.04
|
| Rate for Payer: Signature Care EPO |
$58.10
|
| Rate for Payer: Signature Care PPO |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$55.16
|
|
|
HEPARIN, PORCINE (PF) 100 UNITS/ML IV SYRG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
117963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
