|
HC Z BIOMET CC CRUCIATE TRAY 63
|
Facility
OP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,245.70
|
| Rate for Payer: Aetna Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,569.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,885.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,358.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,256.15
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Centivo All Commercial |
$3,169.80
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Humana Medicare |
$3,169.80
|
| Rate for Payer: Lucent All Commercial |
$3,169.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,423.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,283.00
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
| Rate for Payer: United Healthcare Medicare |
$2,051.05
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 63
|
Facility
IP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,661.47 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,370.01
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 67
|
Facility
IP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,661.47 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,370.01
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 67
|
Facility
OP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41602626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,245.70
|
| Rate for Payer: Aetna Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,569.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,885.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,358.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,256.15
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Centivo All Commercial |
$3,169.80
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Humana Medicare |
$3,169.80
|
| Rate for Payer: Lucent All Commercial |
$3,169.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,423.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,283.00
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
| Rate for Payer: United Healthcare Medicare |
$2,051.05
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 71
|
Facility
IP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,661.47 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,370.01
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 71
|
Facility
OP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,245.70
|
| Rate for Payer: Aetna Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,569.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,885.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,358.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,256.15
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Centivo All Commercial |
$3,169.80
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Humana Medicare |
$3,169.80
|
| Rate for Payer: Lucent All Commercial |
$3,169.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,423.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,283.00
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
| Rate for Payer: United Healthcare Medicare |
$2,051.05
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 75
|
Facility
OP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,245.70
|
| Rate for Payer: Aetna Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,569.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,885.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,358.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,256.15
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Centivo All Commercial |
$3,169.80
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Humana Medicare |
$3,169.80
|
| Rate for Payer: Lucent All Commercial |
$3,169.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,423.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,283.00
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
| Rate for Payer: United Healthcare Medicare |
$2,051.05
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 75
|
Facility
IP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,661.47 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,370.01
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 79
|
Facility
IP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,661.47 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,370.01
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 79
|
Facility
OP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,245.70
|
| Rate for Payer: Aetna Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,569.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,885.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,358.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,256.15
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Centivo All Commercial |
$3,169.80
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Humana Medicare |
$3,169.80
|
| Rate for Payer: Lucent All Commercial |
$3,169.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,423.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,283.00
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
| Rate for Payer: United Healthcare Medicare |
$2,051.05
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 83
|
Facility
OP
|
$6,215.29
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,245.70
|
| Rate for Payer: Aetna Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,569.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,885.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,358.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,256.15
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Centivo All Commercial |
$3,169.80
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Humana Medicare |
$3,169.80
|
| Rate for Payer: Lucent All Commercial |
$3,169.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,423.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,283.00
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
| Rate for Payer: United Healthcare Medicare |
$2,051.05
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 83
|
Facility
IP
|
$6,215.29
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,661.47 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,370.01
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 87
|
Facility
IP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,661.47 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,370.01
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
|
|
HC Z BIOMET CC CRUCIATE TRAY 87
|
Facility
OP
|
$6,215.29
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,780.22 |
| Rate for Payer: Aetna Commercial |
$5,245.70
|
| Rate for Payer: Aetna Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,051.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,569.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,885.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,358.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,256.15
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Cash Price |
$3,853.48
|
| Rate for Payer: Centivo All Commercial |
$3,169.80
|
| Rate for Payer: Cigna All Commercial |
$5,363.80
|
| Rate for Payer: CORVEL All Commercial |
$5,780.22
|
| Rate for Payer: Coventry All Commercial |
$5,469.46
|
| Rate for Payer: Encore All Commercial |
$5,721.17
|
| Rate for Payer: Frontpath All Commercial |
$5,718.07
|
| Rate for Payer: Humana ChoiceCare |
$5,368.15
|
| Rate for Payer: Humana Medicare |
$3,169.80
|
| Rate for Payer: Lucent All Commercial |
$3,169.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,593.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,661.47
|
| Rate for Payer: PHP All Commercial |
$4,713.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,423.96
|
| Rate for Payer: Sagamore Health Network All Products |
$4,798.20
|
| Rate for Payer: Signature Care EPO |
$5,158.69
|
| Rate for Payer: Signature Care PPO |
$5,469.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,283.00
|
| Rate for Payer: United Healthcare Commercial |
$4,897.65
|
| Rate for Payer: United Healthcare Medicare |
$2,051.05
|
|
|
HC Z BLADE 19X90X1.27
|
Facility
IP
|
$455.00
|
|
| Hospital Charge Code |
41605485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cigna All Commercial |
$392.66
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
|
|
HC Z BLADE 19X90X1.27
|
Facility
OP
|
$455.00
|
|
| Hospital Charge Code |
41605485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$384.02
|
| Rate for Payer: Aetna Medicare |
$150.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$261.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$284.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.16
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Centivo All Commercial |
$232.05
|
| Rate for Payer: Cigna All Commercial |
$392.66
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Humana Medicare |
$232.05
|
| Rate for Payer: Lucent All Commercial |
$232.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.45
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$386.75
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
| Rate for Payer: United Healthcare Medicare |
$150.15
|
|
|
HC Z BLADE HIP STEM REMOVAL
|
Facility
OP
|
$8,359.20
|
|
| Hospital Charge Code |
41608315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$7,774.06 |
| Rate for Payer: Aetna Commercial |
$7,055.16
|
| Rate for Payer: Aetna Medicare |
$2,758.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,758.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,800.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,225.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,172.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,034.39
|
| Rate for Payer: Cash Price |
$5,182.70
|
| Rate for Payer: Cash Price |
$5,182.70
|
| Rate for Payer: Centivo All Commercial |
$4,263.19
|
| Rate for Payer: Cigna All Commercial |
$7,213.99
|
| Rate for Payer: CORVEL All Commercial |
$7,774.06
|
| Rate for Payer: Coventry All Commercial |
$7,356.10
|
| Rate for Payer: Encore All Commercial |
$7,694.64
|
| Rate for Payer: Frontpath All Commercial |
$7,690.46
|
| Rate for Payer: Humana ChoiceCare |
$7,219.84
|
| Rate for Payer: Humana Medicare |
$4,263.19
|
| Rate for Payer: Lucent All Commercial |
$4,263.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,523.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6,269.40
|
| Rate for Payer: PHP All Commercial |
$6,339.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,260.09
|
| Rate for Payer: Sagamore Health Network All Products |
$6,453.30
|
| Rate for Payer: Signature Care EPO |
$6,938.14
|
| Rate for Payer: Signature Care PPO |
$7,356.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,105.32
|
| Rate for Payer: United Healthcare Commercial |
$6,587.05
|
| Rate for Payer: United Healthcare Medicare |
$2,758.54
|
|
|
HC Z BLADE HIP STEM REMOVAL
|
Facility
IP
|
$8,359.20
|
|
| Hospital Charge Code |
41608315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,269.40 |
| Max. Negotiated Rate |
$7,774.06 |
| Rate for Payer: Aetna Commercial |
$7,222.35
|
| Rate for Payer: Cash Price |
$5,182.70
|
| Rate for Payer: Cigna All Commercial |
$7,213.99
|
| Rate for Payer: CORVEL All Commercial |
$7,774.06
|
| Rate for Payer: Coventry All Commercial |
$7,356.10
|
| Rate for Payer: Encore All Commercial |
$7,694.64
|
| Rate for Payer: Frontpath All Commercial |
$7,690.46
|
| Rate for Payer: Humana ChoiceCare |
$7,219.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,523.28
|
| Rate for Payer: PHCS All Commercial |
$6,269.40
|
| Rate for Payer: PHP All Commercial |
$6,339.62
|
| Rate for Payer: Sagamore Health Network All Products |
$6,453.30
|
| Rate for Payer: Signature Care EPO |
$6,938.14
|
| Rate for Payer: Signature Care PPO |
$7,356.10
|
| Rate for Payer: United Healthcare Commercial |
$6,587.05
|
|
|
HC Z BLADE OXF CMNTD
|
Facility
OP
|
$2,160.00
|
|
| Hospital Charge Code |
41607516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Aetna Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$712.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,240.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,350.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$819.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.08
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Centivo All Commercial |
$1,101.60
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Humana Medicare |
$1,101.60
|
| Rate for Payer: Lucent All Commercial |
$1,101.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare Medicare |
$712.80
|
|
|
HC Z BLADE OXF CMNTD
|
Facility
IP
|
$2,160.00
|
|
| Hospital Charge Code |
41607516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$2,008.80 |
| Rate for Payer: Aetna Commercial |
$1,866.24
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cigna All Commercial |
$1,864.08
|
| Rate for Payer: CORVEL All Commercial |
$2,008.80
|
| Rate for Payer: Coventry All Commercial |
$1,900.80
|
| Rate for Payer: Encore All Commercial |
$1,988.28
|
| Rate for Payer: Frontpath All Commercial |
$1,987.20
|
| Rate for Payer: Humana ChoiceCare |
$1,865.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,944.00
|
| Rate for Payer: PHCS All Commercial |
$1,620.00
|
| Rate for Payer: PHP All Commercial |
$1,638.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,667.52
|
| Rate for Payer: Signature Care EPO |
$1,792.80
|
| Rate for Payer: Signature Care PPO |
$1,900.80
|
| Rate for Payer: United Healthcare Commercial |
$1,702.08
|
|
|
HC Z BLADE RECIP 12.5X76X1.19L
|
Facility
OP
|
$399.00
|
|
| Hospital Charge Code |
41608295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Encore All Commercial |
$367.28
|
| Rate for Payer: Frontpath All Commercial |
$367.08
|
| Rate for Payer: Humana ChoiceCare |
$344.62
|
| Rate for Payer: Humana Medicare |
$203.49
|
| Rate for Payer: Lucent All Commercial |
$203.49
|
| Rate for Payer: Centivo All Commercial |
$203.49
|
| Rate for Payer: Cigna All Commercial |
$344.34
|
| Rate for Payer: CORVEL All Commercial |
$371.07
|
| Rate for Payer: Coventry All Commercial |
$351.12
|
| Rate for Payer: Aetna Commercial |
$336.76
|
| Rate for Payer: Aetna Medicare |
$131.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$229.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.84
|
| Rate for Payer: Cash Price |
$247.38
|
| Rate for Payer: Cash Price |
$247.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$359.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$299.25
|
| Rate for Payer: PHP All Commercial |
$302.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.61
|
| Rate for Payer: Sagamore Health Network All Products |
$308.03
|
| Rate for Payer: Signature Care EPO |
$331.17
|
| Rate for Payer: Signature Care PPO |
$351.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$314.41
|
| Rate for Payer: United Healthcare Medicare |
$131.67
|
|
|
HC Z BLADE RECIP 12.5X76X1.19L
|
Facility
IP
|
$399.00
|
|
| Hospital Charge Code |
41608295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna Commercial |
$344.74
|
| Rate for Payer: Cash Price |
$247.38
|
| Rate for Payer: Cigna All Commercial |
$344.34
|
| Rate for Payer: CORVEL All Commercial |
$371.07
|
| Rate for Payer: Coventry All Commercial |
$351.12
|
| Rate for Payer: Encore All Commercial |
$367.28
|
| Rate for Payer: Frontpath All Commercial |
$367.08
|
| Rate for Payer: Humana ChoiceCare |
$344.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$359.10
|
| Rate for Payer: PHCS All Commercial |
$299.25
|
| Rate for Payer: PHP All Commercial |
$302.60
|
| Rate for Payer: Sagamore Health Network All Products |
$308.03
|
| Rate for Payer: Signature Care EPO |
$331.17
|
| Rate for Payer: Signature Care PPO |
$351.12
|
| Rate for Payer: United Healthcare Commercial |
$314.41
|
|
|
HC Z BLADE SAW OSC 25X90X1.37G
|
Facility
IP
|
$455.00
|
|
| Hospital Charge Code |
41606377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cigna All Commercial |
$392.66
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
|
|
HC Z BLADE SAW OSC 25X90X1.37G
|
Facility
OP
|
$455.00
|
|
| Hospital Charge Code |
41606377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$384.02
|
| Rate for Payer: Aetna Medicare |
$150.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$150.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$261.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$284.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.16
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Centivo All Commercial |
$232.05
|
| Rate for Payer: Cigna All Commercial |
$392.66
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Humana Medicare |
$232.05
|
| Rate for Payer: Lucent All Commercial |
$232.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.45
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$386.75
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
| Rate for Payer: United Healthcare Medicare |
$150.15
|
|
|
HC Z BLADE SAW OSC 65X35X1.19
|
Facility
IP
|
$455.00
|
|
| Hospital Charge Code |
41606952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cigna All Commercial |
$392.66
|
| Rate for Payer: CORVEL All Commercial |
$423.15
|
| Rate for Payer: Coventry All Commercial |
$400.40
|
| Rate for Payer: Encore All Commercial |
$418.83
|
| Rate for Payer: Frontpath All Commercial |
$418.60
|
| Rate for Payer: Humana ChoiceCare |
$392.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$409.50
|
| Rate for Payer: PHCS All Commercial |
$341.25
|
| Rate for Payer: PHP All Commercial |
$345.07
|
| Rate for Payer: Sagamore Health Network All Products |
$351.26
|
| Rate for Payer: Signature Care EPO |
$377.65
|
| Rate for Payer: Signature Care PPO |
$400.40
|
| Rate for Payer: United Healthcare Commercial |
$358.54
|
|
