|
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
|
|
|
HC Z BLADE SAW RECIP 10X70X1.19
|
Facility
IP
|
$399.00
|
|
| Hospital Charge Code |
41607066
|
|
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 RECIP 10X70X1.19
|
Facility
OP
|
$399.00
|
|
| Hospital Charge Code |
41607066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$371.07 |
| 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: 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: 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: 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 BLK MOD 28 STD NK
|
Facility
OP
|
$8,143.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,573.18 |
| Rate for Payer: Aetna Commercial |
$6,872.86
|
| Rate for Payer: Aetna Medicare |
$2,687.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,687.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,676.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,090.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,090.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,955.98
|
| Rate for Payer: Cash Price |
$5,048.78
|
| Rate for Payer: Cash Price |
$5,048.78
|
| Rate for Payer: Centivo All Commercial |
$4,153.03
|
| Rate for Payer: Cigna All Commercial |
$7,027.58
|
| Rate for Payer: CORVEL All Commercial |
$7,573.18
|
| Rate for Payer: Coventry All Commercial |
$7,166.02
|
| Rate for Payer: Encore All Commercial |
$7,495.82
|
| Rate for Payer: Frontpath All Commercial |
$7,491.74
|
| Rate for Payer: Humana ChoiceCare |
$7,033.28
|
| Rate for Payer: Humana Medicare |
$4,153.03
|
| Rate for Payer: Lucent All Commercial |
$4,153.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,328.88
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,107.40
|
| Rate for Payer: PHP All Commercial |
$6,175.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,175.85
|
| Rate for Payer: Sagamore Health Network All Products |
$6,286.55
|
| Rate for Payer: Signature Care EPO |
$6,758.86
|
| Rate for Payer: Signature Care PPO |
$7,166.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,921.72
|
| Rate for Payer: United Healthcare Commercial |
$6,416.84
|
| Rate for Payer: United Healthcare Medicare |
$2,687.26
|
|
|
HC Z BLK MOD 28 STD NK
|
Facility
IP
|
$8,143.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,107.40 |
| Max. Negotiated Rate |
$7,573.18 |
| Rate for Payer: Aetna Commercial |
$7,035.72
|
| Rate for Payer: Cash Price |
$5,048.78
|
| Rate for Payer: Cigna All Commercial |
$7,027.58
|
| Rate for Payer: CORVEL All Commercial |
$7,573.18
|
| Rate for Payer: Coventry All Commercial |
$7,166.02
|
| Rate for Payer: Encore All Commercial |
$7,495.82
|
| Rate for Payer: Frontpath All Commercial |
$7,491.74
|
| Rate for Payer: Humana ChoiceCare |
$7,033.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,328.88
|
| Rate for Payer: PHCS All Commercial |
$6,107.40
|
| Rate for Payer: PHP All Commercial |
$6,175.80
|
| Rate for Payer: Sagamore Health Network All Products |
$6,286.55
|
| Rate for Payer: Signature Care EPO |
$6,758.86
|
| Rate for Payer: Signature Care PPO |
$7,166.02
|
| Rate for Payer: United Healthcare Commercial |
$6,416.84
|
|
|
HC Z BLX D HEAD TPR T16/18 28
|
Facility
OP
|
$10,886.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,123.98 |
| Rate for Payer: Aetna Commercial |
$9,187.78
|
| Rate for Payer: Aetna Medicare |
$3,592.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,592.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,251.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,804.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,131.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,951.62
|
| Rate for Payer: Cash Price |
$6,749.32
|
| Rate for Payer: Cash Price |
$6,749.32
|
| Rate for Payer: Centivo All Commercial |
$5,551.86
|
| Rate for Payer: Cigna All Commercial |
$9,394.62
|
| Rate for Payer: CORVEL All Commercial |
$10,123.98
|
| Rate for Payer: Coventry All Commercial |
$9,579.68
|
| Rate for Payer: Encore All Commercial |
$10,020.56
|
| Rate for Payer: Frontpath All Commercial |
$10,015.12
|
| Rate for Payer: Humana ChoiceCare |
$9,402.24
|
| Rate for Payer: Humana Medicare |
$5,551.86
|
| Rate for Payer: Lucent All Commercial |
$5,551.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,797.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,164.50
|
| Rate for Payer: PHP All Commercial |
$8,255.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,245.54
|
| Rate for Payer: Sagamore Health Network All Products |
$8,403.99
|
| Rate for Payer: Signature Care EPO |
$9,035.38
|
| Rate for Payer: Signature Care PPO |
$9,579.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,253.10
|
| Rate for Payer: United Healthcare Commercial |
$8,578.17
|
| Rate for Payer: United Healthcare Medicare |
$3,592.38
|
|
|
HC Z BLX D HEAD TPR T16/18 28
|
Facility
IP
|
$10,886.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,164.50 |
| Max. Negotiated Rate |
$10,123.98 |
| Rate for Payer: Aetna Commercial |
$9,405.50
|
| Rate for Payer: Cash Price |
$6,749.32
|
| Rate for Payer: Cigna All Commercial |
$9,394.62
|
| Rate for Payer: CORVEL All Commercial |
$10,123.98
|
| Rate for Payer: Coventry All Commercial |
$9,579.68
|
| Rate for Payer: Encore All Commercial |
$10,020.56
|
| Rate for Payer: Frontpath All Commercial |
$10,015.12
|
| Rate for Payer: Humana ChoiceCare |
$9,402.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,797.40
|
| Rate for Payer: PHCS All Commercial |
$8,164.50
|
| Rate for Payer: PHP All Commercial |
$8,255.94
|
| Rate for Payer: Sagamore Health Network All Products |
$8,403.99
|
| Rate for Payer: Signature Care EPO |
$9,035.38
|
| Rate for Payer: Signature Care PPO |
$9,579.68
|
| Rate for Payer: United Healthcare Commercial |
$8,578.17
|
|
|
HC Z BLX D HEAD TPR T16/18 36
|
Facility
OP
|
$12,552.73
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$11,674.04 |
| Rate for Payer: Aetna Commercial |
$10,594.50
|
| Rate for Payer: Aetna Medicare |
$4,142.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,142.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,209.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,846.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,763.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,556.64
|
| Rate for Payer: Cash Price |
$7,782.69
|
| Rate for Payer: Cash Price |
$7,782.69
|
| Rate for Payer: Centivo All Commercial |
$6,401.89
|
| Rate for Payer: Cigna All Commercial |
$10,833.01
|
| Rate for Payer: CORVEL All Commercial |
$11,674.04
|
| Rate for Payer: Coventry All Commercial |
$11,046.40
|
| Rate for Payer: Encore All Commercial |
$11,554.79
|
| Rate for Payer: Frontpath All Commercial |
$11,548.51
|
| Rate for Payer: Humana ChoiceCare |
$10,841.79
|
| Rate for Payer: Humana Medicare |
$6,401.89
|
| Rate for Payer: Lucent All Commercial |
$6,401.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,297.46
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$9,414.55
|
| Rate for Payer: PHP All Commercial |
$9,519.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,895.56
|
| Rate for Payer: Sagamore Health Network All Products |
$9,690.71
|
| Rate for Payer: Signature Care EPO |
$10,418.77
|
| Rate for Payer: Signature Care PPO |
$11,046.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,669.82
|
| Rate for Payer: United Healthcare Commercial |
$9,891.55
|
| Rate for Payer: United Healthcare Medicare |
$4,142.40
|
|
|
HC Z BLX D HEAD TPR T16/18 36
|
Facility
IP
|
$12,552.73
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,414.55 |
| Max. Negotiated Rate |
$11,674.04 |
| Rate for Payer: Aetna Commercial |
$10,845.56
|
| Rate for Payer: Cash Price |
$7,782.69
|
| Rate for Payer: Cigna All Commercial |
$10,833.01
|
| Rate for Payer: CORVEL All Commercial |
$11,674.04
|
| Rate for Payer: Coventry All Commercial |
$11,046.40
|
| Rate for Payer: Encore All Commercial |
$11,554.79
|
| Rate for Payer: Frontpath All Commercial |
$11,548.51
|
| Rate for Payer: Humana ChoiceCare |
$10,841.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,297.46
|
| Rate for Payer: PHCS All Commercial |
$9,414.55
|
| Rate for Payer: PHP All Commercial |
$9,519.99
|
| Rate for Payer: Sagamore Health Network All Products |
$9,690.71
|
| Rate for Payer: Signature Care EPO |
$10,418.77
|
| Rate for Payer: Signature Care PPO |
$11,046.40
|
| Rate for Payer: United Healthcare Commercial |
$9,891.55
|
|
|
HC Z BLX D HEAD TPR T16X18 40
|
Facility
IP
|
$9,200.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,900.56 |
| Max. Negotiated Rate |
$8,556.69 |
| Rate for Payer: Aetna Commercial |
$7,949.44
|
| Rate for Payer: Cash Price |
$5,704.46
|
| Rate for Payer: Cigna All Commercial |
$7,940.24
|
| Rate for Payer: CORVEL All Commercial |
$8,556.69
|
| Rate for Payer: Coventry All Commercial |
$8,096.65
|
| Rate for Payer: Encore All Commercial |
$8,469.28
|
| Rate for Payer: Frontpath All Commercial |
$8,464.68
|
| Rate for Payer: Humana ChoiceCare |
$7,946.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,280.67
|
| Rate for Payer: PHCS All Commercial |
$6,900.56
|
| Rate for Payer: PHP All Commercial |
$6,977.84
|
| Rate for Payer: Sagamore Health Network All Products |
$7,102.97
|
| Rate for Payer: Signature Care EPO |
$7,636.61
|
| Rate for Payer: Signature Care PPO |
$8,096.65
|
| Rate for Payer: United Healthcare Commercial |
$7,250.18
|
|
|
HC Z BLX D HEAD TPR T16X18 40
|
Facility
OP
|
$9,200.74
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,556.69 |
| Rate for Payer: Aetna Commercial |
$7,765.42
|
| Rate for Payer: Aetna Medicare |
$3,036.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,036.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,283.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,751.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,491.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,339.87
|
| Rate for Payer: Cash Price |
$5,704.46
|
| Rate for Payer: Cash Price |
$5,704.46
|
| Rate for Payer: Centivo All Commercial |
$4,692.38
|
| Rate for Payer: Cigna All Commercial |
$7,940.24
|
| Rate for Payer: CORVEL All Commercial |
$8,556.69
|
| Rate for Payer: Coventry All Commercial |
$8,096.65
|
| Rate for Payer: Encore All Commercial |
$8,469.28
|
| Rate for Payer: Frontpath All Commercial |
$8,464.68
|
| Rate for Payer: Humana ChoiceCare |
$7,946.68
|
| Rate for Payer: Humana Medicare |
$4,692.38
|
| Rate for Payer: Lucent All Commercial |
$4,692.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,280.67
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,900.56
|
| Rate for Payer: PHP All Commercial |
$6,977.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,588.29
|
| Rate for Payer: Sagamore Health Network All Products |
$7,102.97
|
| Rate for Payer: Signature Care EPO |
$7,636.61
|
| Rate for Payer: Signature Care PPO |
$8,096.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,820.63
|
| Rate for Payer: United Healthcare Commercial |
$7,250.18
|
| Rate for Payer: United Healthcare Medicare |
$3,036.24
|
|
|
HC Z BLX SLEVE TPR +3NECK T1
|
Facility
OP
|
$966.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.78 |
| Max. Negotiated Rate |
$898.38 |
| Rate for Payer: Aetna Commercial |
$815.30
|
| Rate for Payer: Aetna Medicare |
$318.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$554.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.66
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Centivo All Commercial |
$492.66
|
| Rate for Payer: Cigna All Commercial |
$833.66
|
| Rate for Payer: CORVEL All Commercial |
$898.38
|
| Rate for Payer: Coventry All Commercial |
$850.08
|
| Rate for Payer: Encore All Commercial |
$889.20
|
| Rate for Payer: Frontpath All Commercial |
$888.72
|
| Rate for Payer: Humana ChoiceCare |
$834.33
|
| Rate for Payer: Humana Medicare |
$492.66
|
| Rate for Payer: Lucent All Commercial |
$492.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$869.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$724.50
|
| Rate for Payer: PHP All Commercial |
$732.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.74
|
| Rate for Payer: Sagamore Health Network All Products |
$745.75
|
| Rate for Payer: Signature Care EPO |
$801.78
|
| Rate for Payer: Signature Care PPO |
$850.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$821.10
|
| Rate for Payer: United Healthcare Commercial |
$761.21
|
| Rate for Payer: United Healthcare Medicare |
$318.78
|
|
|
HC Z BLX SLEVE TPR +3NECK T1
|
Facility
IP
|
$966.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.50 |
| Max. Negotiated Rate |
$898.38 |
| Rate for Payer: Aetna Commercial |
$834.62
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cigna All Commercial |
$833.66
|
| Rate for Payer: CORVEL All Commercial |
$898.38
|
| Rate for Payer: Coventry All Commercial |
$850.08
|
| Rate for Payer: Encore All Commercial |
$889.20
|
| Rate for Payer: Frontpath All Commercial |
$888.72
|
| Rate for Payer: Humana ChoiceCare |
$834.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$869.40
|
| Rate for Payer: PHCS All Commercial |
$724.50
|
| Rate for Payer: PHP All Commercial |
$732.61
|
| Rate for Payer: Sagamore Health Network All Products |
$745.75
|
| Rate for Payer: Signature Care EPO |
$801.78
|
| Rate for Payer: Signature Care PPO |
$850.08
|
| Rate for Payer: United Healthcare Commercial |
$761.21
|
|
|
HC Z BLX SLEVE TPR +6 NECK T1
|
Facility
OP
|
$966.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.78 |
| Max. Negotiated Rate |
$898.38 |
| Rate for Payer: Aetna Commercial |
$815.30
|
| Rate for Payer: Aetna Medicare |
$318.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$554.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.66
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Centivo All Commercial |
$492.66
|
| Rate for Payer: Cigna All Commercial |
$833.66
|
| Rate for Payer: CORVEL All Commercial |
$898.38
|
| Rate for Payer: Coventry All Commercial |
$850.08
|
| Rate for Payer: Encore All Commercial |
$889.20
|
| Rate for Payer: Frontpath All Commercial |
$888.72
|
| Rate for Payer: Humana ChoiceCare |
$834.33
|
| Rate for Payer: Humana Medicare |
$492.66
|
| Rate for Payer: Lucent All Commercial |
$492.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$869.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$724.50
|
| Rate for Payer: PHP All Commercial |
$732.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.74
|
| Rate for Payer: Sagamore Health Network All Products |
$745.75
|
| Rate for Payer: Signature Care EPO |
$801.78
|
| Rate for Payer: Signature Care PPO |
$850.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$821.10
|
| Rate for Payer: United Healthcare Commercial |
$761.21
|
| Rate for Payer: United Healthcare Medicare |
$318.78
|
|
|
HC Z BLX SLEVE TPR +6 NECK T1
|
Facility
IP
|
$966.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.50 |
| Max. Negotiated Rate |
$898.38 |
| Rate for Payer: Aetna Commercial |
$834.62
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cigna All Commercial |
$833.66
|
| Rate for Payer: CORVEL All Commercial |
$898.38
|
| Rate for Payer: Coventry All Commercial |
$850.08
|
| Rate for Payer: Encore All Commercial |
$889.20
|
| Rate for Payer: Frontpath All Commercial |
$888.72
|
| Rate for Payer: Humana ChoiceCare |
$834.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$869.40
|
| Rate for Payer: PHCS All Commercial |
$724.50
|
| Rate for Payer: PHP All Commercial |
$732.61
|
| Rate for Payer: Sagamore Health Network All Products |
$745.75
|
| Rate for Payer: Signature Care EPO |
$801.78
|
| Rate for Payer: Signature Care PPO |
$850.08
|
| Rate for Payer: United Healthcare Commercial |
$761.21
|
|
|
HC Z BLX SLEVE TPR -6NECK T1
|
Facility
IP
|
$966.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.50 |
| Max. Negotiated Rate |
$898.38 |
| Rate for Payer: Aetna Commercial |
$834.62
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cigna All Commercial |
$833.66
|
| Rate for Payer: CORVEL All Commercial |
$898.38
|
| Rate for Payer: Coventry All Commercial |
$850.08
|
| Rate for Payer: Encore All Commercial |
$889.20
|
| Rate for Payer: Frontpath All Commercial |
$888.72
|
| Rate for Payer: Humana ChoiceCare |
$834.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$869.40
|
| Rate for Payer: PHCS All Commercial |
$724.50
|
| Rate for Payer: PHP All Commercial |
$732.61
|
| Rate for Payer: Sagamore Health Network All Products |
$745.75
|
| Rate for Payer: Signature Care EPO |
$801.78
|
| Rate for Payer: Signature Care PPO |
$850.08
|
| Rate for Payer: United Healthcare Commercial |
$761.21
|
|
|
HC Z BLX SLEVE TPR -6NECK T1
|
Facility
OP
|
$966.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.78 |
| Max. Negotiated Rate |
$898.38 |
| Rate for Payer: Aetna Commercial |
$815.30
|
| Rate for Payer: Aetna Medicare |
$318.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$554.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.66
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Centivo All Commercial |
$492.66
|
| Rate for Payer: Cigna All Commercial |
$833.66
|
| Rate for Payer: CORVEL All Commercial |
$898.38
|
| Rate for Payer: Coventry All Commercial |
$850.08
|
| Rate for Payer: Encore All Commercial |
$889.20
|
| Rate for Payer: Frontpath All Commercial |
$888.72
|
| Rate for Payer: Humana ChoiceCare |
$834.33
|
| Rate for Payer: Humana Medicare |
$492.66
|
| Rate for Payer: Lucent All Commercial |
$492.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$869.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$724.50
|
| Rate for Payer: PHP All Commercial |
$732.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.74
|
| Rate for Payer: Sagamore Health Network All Products |
$745.75
|
| Rate for Payer: Signature Care EPO |
$801.78
|
| Rate for Payer: Signature Care PPO |
$850.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$821.10
|
| Rate for Payer: United Healthcare Commercial |
$761.21
|
| Rate for Payer: United Healthcare Medicare |
$318.78
|
|
|
HC Z BONE CEMENT R
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$354.48
|
| Rate for Payer: Aetna Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$262.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.46
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Centivo All Commercial |
$214.20
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Lucent All Commercial |
$214.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$163.80
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
|
|
HC Z BONE CEMENT R
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna Commercial |
$362.88
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna All Commercial |
$362.46
|
| Rate for Payer: CORVEL All Commercial |
$390.60
|
| Rate for Payer: Coventry All Commercial |
$369.60
|
| Rate for Payer: Encore All Commercial |
$386.61
|
| Rate for Payer: Frontpath All Commercial |
$386.40
|
| Rate for Payer: Humana ChoiceCare |
$362.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: PHCS All Commercial |
$315.00
|
| Rate for Payer: PHP All Commercial |
$318.53
|
| Rate for Payer: Sagamore Health Network All Products |
$324.24
|
| Rate for Payer: Signature Care EPO |
$348.60
|
| Rate for Payer: Signature Care PPO |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$330.96
|
|
|
HC Z BONE CUBES CANC.
|
Facility
OP
|
$1,390.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.86 |
| Max. Negotiated Rate |
$1,293.16 |
| Rate for Payer: Aetna Commercial |
$1,173.58
|
| Rate for Payer: Aetna Medicare |
$458.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$458.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$798.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$869.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$527.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$504.75
|
| Rate for Payer: Cash Price |
$862.11
|
| Rate for Payer: Cash Price |
$862.11
|
| Rate for Payer: Centivo All Commercial |
$709.16
|
| Rate for Payer: Cigna All Commercial |
$1,200.00
|
| Rate for Payer: CORVEL All Commercial |
$1,293.16
|
| Rate for Payer: Coventry All Commercial |
$1,223.64
|
| Rate for Payer: Encore All Commercial |
$1,279.96
|
| Rate for Payer: Frontpath All Commercial |
$1,279.26
|
| Rate for Payer: Humana ChoiceCare |
$1,200.97
|
| Rate for Payer: Humana Medicare |
$709.16
|
| Rate for Payer: Lucent All Commercial |
$709.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,251.45
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,042.88
|
| Rate for Payer: PHP All Commercial |
$1,054.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$542.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,073.47
|
| Rate for Payer: Signature Care EPO |
$1,154.12
|
| Rate for Payer: Signature Care PPO |
$1,223.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,181.92
|
| Rate for Payer: United Healthcare Commercial |
$1,095.71
|
| Rate for Payer: United Healthcare Medicare |
$458.86
|
|
|
HC Z BONE CUBES CANC.
|
Facility
IP
|
$1,390.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.88 |
| Max. Negotiated Rate |
$1,293.16 |
| Rate for Payer: Aetna Commercial |
$1,201.39
|
| Rate for Payer: Cash Price |
$862.11
|
| Rate for Payer: Cigna All Commercial |
$1,200.00
|
| Rate for Payer: CORVEL All Commercial |
$1,293.16
|
| Rate for Payer: Coventry All Commercial |
$1,223.64
|
| Rate for Payer: Encore All Commercial |
$1,279.96
|
| Rate for Payer: Frontpath All Commercial |
$1,279.26
|
| Rate for Payer: Humana ChoiceCare |
$1,200.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,251.45
|
| Rate for Payer: PHCS All Commercial |
$1,042.88
|
| Rate for Payer: PHP All Commercial |
$1,054.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,073.47
|
| Rate for Payer: Signature Care EPO |
$1,154.12
|
| Rate for Payer: Signature Care PPO |
$1,223.64
|
| Rate for Payer: United Healthcare Commercial |
$1,095.71
|
|
|
HC Z BURR MILL
|
Facility
OP
|
$777.40
|
|
| Hospital Charge Code |
41605843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$722.98 |
| Rate for Payer: Aetna Commercial |
$656.13
|
| Rate for Payer: Aetna Medicare |
$256.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$485.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.20
|
| Rate for Payer: Cash Price |
$481.99
|
| Rate for Payer: Cash Price |
$481.99
|
| Rate for Payer: Centivo All Commercial |
$396.47
|
| Rate for Payer: Cigna All Commercial |
$670.90
|
| Rate for Payer: CORVEL All Commercial |
$722.98
|
| Rate for Payer: Coventry All Commercial |
$684.11
|
| Rate for Payer: Encore All Commercial |
$715.60
|
| Rate for Payer: Frontpath All Commercial |
$715.21
|
| Rate for Payer: Humana ChoiceCare |
$671.44
|
| Rate for Payer: Humana Medicare |
$396.47
|
| Rate for Payer: Lucent All Commercial |
$396.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.66
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$583.05
|
| Rate for Payer: PHP All Commercial |
$589.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.19
|
| Rate for Payer: Sagamore Health Network All Products |
$600.15
|
| Rate for Payer: Signature Care EPO |
$645.24
|
| Rate for Payer: Signature Care PPO |
$684.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$660.79
|
| Rate for Payer: United Healthcare Commercial |
$612.59
|
| Rate for Payer: United Healthcare Medicare |
$256.54
|
|
|
HC Z BURR MILL
|
Facility
IP
|
$777.40
|
|
| Hospital Charge Code |
41605843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.05 |
| Max. Negotiated Rate |
$722.98 |
| Rate for Payer: Aetna Commercial |
$671.67
|
| Rate for Payer: Cash Price |
$481.99
|
| Rate for Payer: Cigna All Commercial |
$670.90
|
| Rate for Payer: CORVEL All Commercial |
$722.98
|
| Rate for Payer: Coventry All Commercial |
$684.11
|
| Rate for Payer: Encore All Commercial |
$715.60
|
| Rate for Payer: Frontpath All Commercial |
$715.21
|
| Rate for Payer: Humana ChoiceCare |
$671.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.66
|
| Rate for Payer: PHCS All Commercial |
$583.05
|
| Rate for Payer: PHP All Commercial |
$589.58
|
| Rate for Payer: Sagamore Health Network All Products |
$600.15
|
| Rate for Payer: Signature Care EPO |
$645.24
|
| Rate for Payer: Signature Care PPO |
$684.11
|
| Rate for Payer: United Healthcare Commercial |
$612.59
|
|
|
HC Z BUTTON 3.5 HEX
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607592
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z BUTTON 3.5 HEX
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607592
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
