|
HC Z CABLE BUTTON 5.5X2.5
|
Facility
OP
|
$798.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.65 |
| Max. Negotiated Rate |
$743.02 |
| Rate for Payer: Aetna Commercial |
$674.31
|
| Rate for Payer: Aetna Medicare |
$263.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$263.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$458.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$499.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.02
|
| Rate for Payer: Cash Price |
$495.35
|
| Rate for Payer: Cash Price |
$495.35
|
| Rate for Payer: Centivo All Commercial |
$407.46
|
| Rate for Payer: Cigna All Commercial |
$689.49
|
| Rate for Payer: CORVEL All Commercial |
$743.02
|
| Rate for Payer: Coventry All Commercial |
$703.08
|
| Rate for Payer: Encore All Commercial |
$735.43
|
| Rate for Payer: Frontpath All Commercial |
$735.03
|
| Rate for Payer: Humana ChoiceCare |
$690.05
|
| Rate for Payer: Humana Medicare |
$407.46
|
| Rate for Payer: Lucent All Commercial |
$407.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$719.06
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$599.21
|
| Rate for Payer: PHP All Commercial |
$605.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$311.59
|
| Rate for Payer: Sagamore Health Network All Products |
$616.79
|
| Rate for Payer: Signature Care EPO |
$663.13
|
| Rate for Payer: Signature Care PPO |
$703.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$679.11
|
| Rate for Payer: United Healthcare Commercial |
$629.57
|
| Rate for Payer: United Healthcare Medicare |
$263.65
|
|
|
HC Z CABLE BUTTON 5.5X2.5
|
Facility
IP
|
$798.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.21 |
| Max. Negotiated Rate |
$743.02 |
| Rate for Payer: Aetna Commercial |
$690.29
|
| Rate for Payer: Cash Price |
$495.35
|
| Rate for Payer: Cigna All Commercial |
$689.49
|
| Rate for Payer: CORVEL All Commercial |
$743.02
|
| Rate for Payer: Coventry All Commercial |
$703.08
|
| Rate for Payer: Encore All Commercial |
$735.43
|
| Rate for Payer: Frontpath All Commercial |
$735.03
|
| Rate for Payer: Humana ChoiceCare |
$690.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$719.06
|
| Rate for Payer: PHCS All Commercial |
$599.21
|
| Rate for Payer: PHP All Commercial |
$605.92
|
| Rate for Payer: Sagamore Health Network All Products |
$616.79
|
| Rate for Payer: Signature Care EPO |
$663.13
|
| Rate for Payer: Signature Care PPO |
$703.08
|
| Rate for Payer: United Healthcare Commercial |
$629.57
|
|
|
HC Z CABLE BUTTON NCB
|
Facility
IP
|
$798.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.21 |
| Max. Negotiated Rate |
$743.02 |
| Rate for Payer: Aetna Commercial |
$690.29
|
| Rate for Payer: Cash Price |
$495.35
|
| Rate for Payer: Cigna All Commercial |
$689.49
|
| Rate for Payer: CORVEL All Commercial |
$743.02
|
| Rate for Payer: Coventry All Commercial |
$703.08
|
| Rate for Payer: Encore All Commercial |
$735.43
|
| Rate for Payer: Frontpath All Commercial |
$735.03
|
| Rate for Payer: Humana ChoiceCare |
$690.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$719.06
|
| Rate for Payer: PHCS All Commercial |
$599.21
|
| Rate for Payer: PHP All Commercial |
$605.92
|
| Rate for Payer: Sagamore Health Network All Products |
$616.79
|
| Rate for Payer: Signature Care EPO |
$663.13
|
| Rate for Payer: Signature Care PPO |
$703.08
|
| Rate for Payer: United Healthcare Commercial |
$629.57
|
|
|
HC Z CABLE BUTTON NCB
|
Facility
OP
|
$798.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.65 |
| Max. Negotiated Rate |
$743.02 |
| Rate for Payer: Aetna Commercial |
$674.31
|
| Rate for Payer: Aetna Medicare |
$263.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$263.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$458.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$499.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.02
|
| Rate for Payer: Cash Price |
$495.35
|
| Rate for Payer: Cash Price |
$495.35
|
| Rate for Payer: Centivo All Commercial |
$407.46
|
| Rate for Payer: Cigna All Commercial |
$689.49
|
| Rate for Payer: CORVEL All Commercial |
$743.02
|
| Rate for Payer: Coventry All Commercial |
$703.08
|
| Rate for Payer: Encore All Commercial |
$735.43
|
| Rate for Payer: Frontpath All Commercial |
$735.03
|
| Rate for Payer: Humana ChoiceCare |
$690.05
|
| Rate for Payer: Humana Medicare |
$407.46
|
| Rate for Payer: Lucent All Commercial |
$407.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$719.06
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$599.21
|
| Rate for Payer: PHP All Commercial |
$605.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$311.59
|
| Rate for Payer: Sagamore Health Network All Products |
$616.79
|
| Rate for Payer: Signature Care EPO |
$663.13
|
| Rate for Payer: Signature Care PPO |
$703.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$679.11
|
| Rate for Payer: United Healthcare Commercial |
$629.57
|
| Rate for Payer: United Healthcare Medicare |
$263.65
|
|
|
HC Z CABLE GRIP W/CRIMP 1.8X635
|
Facility
OP
|
$1,764.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,640.85 |
| Rate for Payer: Aetna Commercial |
$1,489.11
|
| Rate for Payer: Aetna Medicare |
$582.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,013.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,102.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$669.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$640.46
|
| Rate for Payer: Cash Price |
$1,093.90
|
| Rate for Payer: Cash Price |
$1,093.90
|
| Rate for Payer: Centivo All Commercial |
$899.82
|
| Rate for Payer: Cigna All Commercial |
$1,522.63
|
| Rate for Payer: CORVEL All Commercial |
$1,640.85
|
| Rate for Payer: Coventry All Commercial |
$1,552.63
|
| Rate for Payer: Encore All Commercial |
$1,624.08
|
| Rate for Payer: Frontpath All Commercial |
$1,623.20
|
| Rate for Payer: Humana ChoiceCare |
$1,523.87
|
| Rate for Payer: Humana Medicare |
$899.82
|
| Rate for Payer: Lucent All Commercial |
$899.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,587.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,323.26
|
| Rate for Payer: PHP All Commercial |
$1,338.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$688.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,362.08
|
| Rate for Payer: Signature Care EPO |
$1,464.41
|
| Rate for Payer: Signature Care PPO |
$1,552.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,499.70
|
| Rate for Payer: United Healthcare Commercial |
$1,390.31
|
| Rate for Payer: United Healthcare Medicare |
$582.24
|
|
|
HC Z CABLE GRIP W/CRIMP 1.8X635
|
Facility
IP
|
$1,764.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,323.26 |
| Max. Negotiated Rate |
$1,640.85 |
| Rate for Payer: Aetna Commercial |
$1,524.40
|
| Rate for Payer: Cash Price |
$1,093.90
|
| Rate for Payer: Cigna All Commercial |
$1,522.63
|
| Rate for Payer: CORVEL All Commercial |
$1,640.85
|
| Rate for Payer: Coventry All Commercial |
$1,552.63
|
| Rate for Payer: Encore All Commercial |
$1,624.08
|
| Rate for Payer: Frontpath All Commercial |
$1,623.20
|
| Rate for Payer: Humana ChoiceCare |
$1,523.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,587.92
|
| Rate for Payer: PHCS All Commercial |
$1,323.26
|
| Rate for Payer: PHP All Commercial |
$1,338.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1,362.08
|
| Rate for Payer: Signature Care EPO |
$1,464.41
|
| Rate for Payer: Signature Care PPO |
$1,552.63
|
| Rate for Payer: United Healthcare Commercial |
$1,390.31
|
|
|
HC Z CABLE PIN 45MM
|
Facility
IP
|
$1,833.59
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,375.19 |
| Max. Negotiated Rate |
$1,705.24 |
| Rate for Payer: Aetna Commercial |
$1,584.22
|
| Rate for Payer: Cash Price |
$1,136.83
|
| Rate for Payer: Cigna All Commercial |
$1,582.39
|
| Rate for Payer: CORVEL All Commercial |
$1,705.24
|
| Rate for Payer: Coventry All Commercial |
$1,613.56
|
| Rate for Payer: Encore All Commercial |
$1,687.82
|
| Rate for Payer: Frontpath All Commercial |
$1,686.90
|
| Rate for Payer: Humana ChoiceCare |
$1,583.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,650.23
|
| Rate for Payer: PHCS All Commercial |
$1,375.19
|
| Rate for Payer: PHP All Commercial |
$1,390.59
|
| Rate for Payer: Sagamore Health Network All Products |
$1,415.53
|
| Rate for Payer: Signature Care EPO |
$1,521.88
|
| Rate for Payer: Signature Care PPO |
$1,613.56
|
| Rate for Payer: United Healthcare Commercial |
$1,444.87
|
|
|
HC Z CABLE PIN 45MM
|
Facility
OP
|
$1,833.59
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,705.24 |
| Rate for Payer: Aetna Commercial |
$1,547.55
|
| Rate for Payer: Aetna Medicare |
$605.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$605.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,053.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,146.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$695.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$665.59
|
| Rate for Payer: Cash Price |
$1,136.83
|
| Rate for Payer: Cash Price |
$1,136.83
|
| Rate for Payer: Centivo All Commercial |
$935.13
|
| Rate for Payer: Cigna All Commercial |
$1,582.39
|
| Rate for Payer: CORVEL All Commercial |
$1,705.24
|
| Rate for Payer: Coventry All Commercial |
$1,613.56
|
| Rate for Payer: Encore All Commercial |
$1,687.82
|
| Rate for Payer: Frontpath All Commercial |
$1,686.90
|
| Rate for Payer: Humana ChoiceCare |
$1,583.67
|
| Rate for Payer: Humana Medicare |
$935.13
|
| Rate for Payer: Lucent All Commercial |
$935.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,650.23
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,375.19
|
| Rate for Payer: PHP All Commercial |
$1,390.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$715.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,415.53
|
| Rate for Payer: Signature Care EPO |
$1,521.88
|
| Rate for Payer: Signature Care PPO |
$1,613.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,558.55
|
| Rate for Payer: United Healthcare Commercial |
$1,444.87
|
| Rate for Payer: United Healthcare Medicare |
$605.08
|
|
|
HC Z CEMENT MIXING SYSTEM
|
Facility
OP
|
$3,240.00
|
|
| Hospital Charge Code |
41604401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,013.20 |
| Rate for Payer: Aetna Commercial |
$2,734.56
|
| Rate for Payer: Aetna Medicare |
$1,069.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,069.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,860.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,025.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,229.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,176.12
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Centivo All Commercial |
$1,652.40
|
| Rate for Payer: Cigna All Commercial |
$2,796.12
|
| Rate for Payer: CORVEL All Commercial |
$3,013.20
|
| Rate for Payer: Coventry All Commercial |
$2,851.20
|
| Rate for Payer: Encore All Commercial |
$2,982.42
|
| Rate for Payer: Frontpath All Commercial |
$2,980.80
|
| Rate for Payer: Humana ChoiceCare |
$2,798.39
|
| Rate for Payer: Humana Medicare |
$1,652.40
|
| Rate for Payer: Lucent All Commercial |
$1,652.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,916.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,430.00
|
| Rate for Payer: PHP All Commercial |
$2,457.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,263.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,501.28
|
| Rate for Payer: Signature Care EPO |
$2,689.20
|
| Rate for Payer: Signature Care PPO |
$2,851.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,754.00
|
| Rate for Payer: United Healthcare Commercial |
$2,553.12
|
| Rate for Payer: United Healthcare Medicare |
$1,069.20
|
|
|
HC Z CEMENT MIXING SYSTEM
|
Facility
IP
|
$3,240.00
|
|
| Hospital Charge Code |
41604401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,430.00 |
| Max. Negotiated Rate |
$3,013.20 |
| Rate for Payer: Aetna Commercial |
$2,799.36
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cigna All Commercial |
$2,796.12
|
| Rate for Payer: CORVEL All Commercial |
$3,013.20
|
| Rate for Payer: Coventry All Commercial |
$2,851.20
|
| Rate for Payer: Encore All Commercial |
$2,982.42
|
| Rate for Payer: Frontpath All Commercial |
$2,980.80
|
| Rate for Payer: Humana ChoiceCare |
$2,798.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,916.00
|
| Rate for Payer: PHCS All Commercial |
$2,430.00
|
| Rate for Payer: PHP All Commercial |
$2,457.22
|
| Rate for Payer: Sagamore Health Network All Products |
$2,501.28
|
| Rate for Payer: Signature Care EPO |
$2,689.20
|
| Rate for Payer: Signature Care PPO |
$2,851.20
|
| Rate for Payer: United Healthcare Commercial |
$2,553.12
|
|
|
HC Z CEMENT REFOBACIN
|
Facility
IP
|
$850.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.50 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cigna All Commercial |
$733.55
|
| Rate for Payer: CORVEL All Commercial |
$790.50
|
| Rate for Payer: Coventry All Commercial |
$748.00
|
| Rate for Payer: Encore All Commercial |
$782.42
|
| Rate for Payer: Frontpath All Commercial |
$782.00
|
| Rate for Payer: Humana ChoiceCare |
$734.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$765.00
|
| Rate for Payer: PHCS All Commercial |
$637.50
|
| Rate for Payer: PHP All Commercial |
$644.64
|
| Rate for Payer: Sagamore Health Network All Products |
$656.20
|
| Rate for Payer: Signature Care EPO |
$705.50
|
| Rate for Payer: Signature Care PPO |
$748.00
|
| Rate for Payer: United Healthcare Commercial |
$669.80
|
|
|
HC Z CEMENT REFOBACIN
|
Facility
OP
|
$850.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Aetna Commercial |
$717.40
|
| Rate for Payer: Aetna Medicare |
$280.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$280.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$488.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$531.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.55
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Centivo All Commercial |
$433.50
|
| Rate for Payer: Cigna All Commercial |
$733.55
|
| Rate for Payer: CORVEL All Commercial |
$790.50
|
| Rate for Payer: Coventry All Commercial |
$748.00
|
| Rate for Payer: Encore All Commercial |
$782.42
|
| Rate for Payer: Frontpath All Commercial |
$782.00
|
| Rate for Payer: Humana ChoiceCare |
$734.14
|
| Rate for Payer: Humana Medicare |
$433.50
|
| Rate for Payer: Lucent All Commercial |
$433.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$637.50
|
| Rate for Payer: PHP All Commercial |
$644.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$331.50
|
| Rate for Payer: Sagamore Health Network All Products |
$656.20
|
| Rate for Payer: Signature Care EPO |
$705.50
|
| Rate for Payer: Signature Care PPO |
$748.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$722.50
|
| Rate for Payer: United Healthcare Commercial |
$669.80
|
| Rate for Payer: United Healthcare Medicare |
$280.50
|
|
|
HC Z CERAMENT BONE VOID FILLER
|
Facility
OP
|
$19,245.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$17,898.41 |
| Rate for Payer: Aetna Commercial |
$16,243.29
|
| Rate for Payer: Aetna Medicare |
$6,351.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,351.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11,052.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,030.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,303.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,986.15
|
| Rate for Payer: Cash Price |
$11,932.27
|
| Rate for Payer: Cash Price |
$11,932.27
|
| Rate for Payer: Centivo All Commercial |
$9,815.26
|
| Rate for Payer: Cigna All Commercial |
$16,608.95
|
| Rate for Payer: CORVEL All Commercial |
$17,898.41
|
| Rate for Payer: Coventry All Commercial |
$16,936.13
|
| Rate for Payer: Encore All Commercial |
$17,715.57
|
| Rate for Payer: Frontpath All Commercial |
$17,705.95
|
| Rate for Payer: Humana ChoiceCare |
$16,622.42
|
| Rate for Payer: Humana Medicare |
$9,815.26
|
| Rate for Payer: Lucent All Commercial |
$9,815.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,321.04
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$14,434.20
|
| Rate for Payer: PHP All Commercial |
$14,595.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,505.78
|
| Rate for Payer: Sagamore Health Network All Products |
$14,857.60
|
| Rate for Payer: Signature Care EPO |
$15,973.85
|
| Rate for Payer: Signature Care PPO |
$16,936.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,358.76
|
| Rate for Payer: United Healthcare Commercial |
$15,165.53
|
| Rate for Payer: United Healthcare Medicare |
$6,351.05
|
|
|
HC Z CERAMENT BONE VOID FILLER
|
Facility
IP
|
$19,245.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,434.20 |
| Max. Negotiated Rate |
$17,898.41 |
| Rate for Payer: Aetna Commercial |
$16,628.20
|
| Rate for Payer: Cash Price |
$11,932.27
|
| Rate for Payer: Cigna All Commercial |
$16,608.95
|
| Rate for Payer: CORVEL All Commercial |
$17,898.41
|
| Rate for Payer: Coventry All Commercial |
$16,936.13
|
| Rate for Payer: Encore All Commercial |
$17,715.57
|
| Rate for Payer: Frontpath All Commercial |
$17,705.95
|
| Rate for Payer: Humana ChoiceCare |
$16,622.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17,321.04
|
| Rate for Payer: PHCS All Commercial |
$14,434.20
|
| Rate for Payer: PHP All Commercial |
$14,595.86
|
| Rate for Payer: Sagamore Health Network All Products |
$14,857.60
|
| Rate for Payer: Signature Care EPO |
$15,973.85
|
| Rate for Payer: Signature Care PPO |
$16,936.13
|
| Rate for Payer: United Healthcare Commercial |
$15,165.53
|
|
|
HC Z CNTRSNK 3.5 4.0 CANN QC
|
Facility
IP
|
$1,664.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,248.38 |
| Max. Negotiated Rate |
$1,547.98 |
| Rate for Payer: Aetna Commercial |
$1,438.13
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Cigna All Commercial |
$1,436.46
|
| Rate for Payer: CORVEL All Commercial |
$1,547.98
|
| Rate for Payer: Coventry All Commercial |
$1,464.76
|
| Rate for Payer: Encore All Commercial |
$1,532.17
|
| Rate for Payer: Frontpath All Commercial |
$1,531.34
|
| Rate for Payer: Humana ChoiceCare |
$1,437.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,498.05
|
| Rate for Payer: PHCS All Commercial |
$1,248.38
|
| Rate for Payer: PHP All Commercial |
$1,262.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,284.99
|
| Rate for Payer: Signature Care EPO |
$1,381.54
|
| Rate for Payer: Signature Care PPO |
$1,464.76
|
| Rate for Payer: United Healthcare Commercial |
$1,311.63
|
|
|
HC Z CNTRSNK 3.5 4.0 CANN QC
|
Facility
OP
|
$1,664.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,547.98 |
| Rate for Payer: Aetna Commercial |
$1,404.84
|
| Rate for Payer: Aetna Medicare |
$549.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$549.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$955.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,040.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$631.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$604.21
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Centivo All Commercial |
$848.90
|
| Rate for Payer: Cigna All Commercial |
$1,436.46
|
| Rate for Payer: CORVEL All Commercial |
$1,547.98
|
| Rate for Payer: Coventry All Commercial |
$1,464.76
|
| Rate for Payer: Encore All Commercial |
$1,532.17
|
| Rate for Payer: Frontpath All Commercial |
$1,531.34
|
| Rate for Payer: Humana ChoiceCare |
$1,437.63
|
| Rate for Payer: Humana Medicare |
$848.90
|
| Rate for Payer: Lucent All Commercial |
$848.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,498.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,248.38
|
| Rate for Payer: PHP All Commercial |
$1,262.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$649.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,284.99
|
| Rate for Payer: Signature Care EPO |
$1,381.54
|
| Rate for Payer: Signature Care PPO |
$1,464.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,414.82
|
| Rate for Payer: United Healthcare Commercial |
$1,311.63
|
| Rate for Payer: United Healthcare Medicare |
$549.28
|
|
|
HC Z CNTRSNK 3.5 4.0 QC
|
Facility
IP
|
$815.57
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.68 |
| Max. Negotiated Rate |
$758.48 |
| Rate for Payer: Aetna Commercial |
$704.65
|
| Rate for Payer: Cash Price |
$505.65
|
| Rate for Payer: Cigna All Commercial |
$703.84
|
| Rate for Payer: CORVEL All Commercial |
$758.48
|
| Rate for Payer: Coventry All Commercial |
$717.70
|
| Rate for Payer: Encore All Commercial |
$750.73
|
| Rate for Payer: Frontpath All Commercial |
$750.32
|
| Rate for Payer: Humana ChoiceCare |
$704.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.01
|
| Rate for Payer: PHCS All Commercial |
$611.68
|
| Rate for Payer: PHP All Commercial |
$618.53
|
| Rate for Payer: Sagamore Health Network All Products |
$629.62
|
| Rate for Payer: Signature Care EPO |
$676.92
|
| Rate for Payer: Signature Care PPO |
$717.70
|
| Rate for Payer: United Healthcare Commercial |
$642.67
|
|
|
HC Z CNTRSNK 3.5 4.0 QC
|
Facility
OP
|
$815.57
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$758.48 |
| Rate for Payer: Aetna Commercial |
$688.34
|
| Rate for Payer: Aetna Medicare |
$269.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$468.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$509.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$309.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$296.05
|
| Rate for Payer: Cash Price |
$505.65
|
| Rate for Payer: Cash Price |
$505.65
|
| Rate for Payer: Centivo All Commercial |
$415.94
|
| Rate for Payer: Cigna All Commercial |
$703.84
|
| Rate for Payer: CORVEL All Commercial |
$758.48
|
| Rate for Payer: Coventry All Commercial |
$717.70
|
| Rate for Payer: Encore All Commercial |
$750.73
|
| Rate for Payer: Frontpath All Commercial |
$750.32
|
| Rate for Payer: Humana ChoiceCare |
$704.41
|
| Rate for Payer: Humana Medicare |
$415.94
|
| Rate for Payer: Lucent All Commercial |
$415.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$611.68
|
| Rate for Payer: PHP All Commercial |
$618.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.07
|
| Rate for Payer: Sagamore Health Network All Products |
$629.62
|
| Rate for Payer: Signature Care EPO |
$676.92
|
| Rate for Payer: Signature Care PPO |
$717.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$693.23
|
| Rate for Payer: United Healthcare Commercial |
$642.67
|
| Rate for Payer: United Healthcare Medicare |
$269.14
|
|
|
HC Z CNTRSNK 6.5 7.0 7.5
|
Facility
OP
|
$1,664.50
|
|
| Hospital Charge Code |
41604086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,547.98 |
| Rate for Payer: Aetna Commercial |
$1,404.84
|
| Rate for Payer: Aetna Medicare |
$549.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$549.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$955.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,040.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$631.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$604.21
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Centivo All Commercial |
$848.90
|
| Rate for Payer: Cigna All Commercial |
$1,436.46
|
| Rate for Payer: CORVEL All Commercial |
$1,547.98
|
| Rate for Payer: Coventry All Commercial |
$1,464.76
|
| Rate for Payer: Encore All Commercial |
$1,532.17
|
| Rate for Payer: Frontpath All Commercial |
$1,531.34
|
| Rate for Payer: Humana ChoiceCare |
$1,437.63
|
| Rate for Payer: Humana Medicare |
$848.90
|
| Rate for Payer: Lucent All Commercial |
$848.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,498.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,248.38
|
| Rate for Payer: PHP All Commercial |
$1,262.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$649.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,284.99
|
| Rate for Payer: Signature Care EPO |
$1,381.54
|
| Rate for Payer: Signature Care PPO |
$1,464.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,414.82
|
| Rate for Payer: United Healthcare Commercial |
$1,311.63
|
| Rate for Payer: United Healthcare Medicare |
$549.28
|
|
|
HC Z CNTRSNK 6.5 7.0 7.5
|
Facility
IP
|
$1,664.50
|
|
| Hospital Charge Code |
41604086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,248.38 |
| Max. Negotiated Rate |
$1,547.98 |
| Rate for Payer: Aetna Commercial |
$1,438.13
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Cigna All Commercial |
$1,436.46
|
| Rate for Payer: CORVEL All Commercial |
$1,547.98
|
| Rate for Payer: Coventry All Commercial |
$1,464.76
|
| Rate for Payer: Encore All Commercial |
$1,532.17
|
| Rate for Payer: Frontpath All Commercial |
$1,531.34
|
| Rate for Payer: Humana ChoiceCare |
$1,437.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,498.05
|
| Rate for Payer: PHCS All Commercial |
$1,248.38
|
| Rate for Payer: PHP All Commercial |
$1,262.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,284.99
|
| Rate for Payer: Signature Care EPO |
$1,381.54
|
| Rate for Payer: Signature Care PPO |
$1,464.76
|
| Rate for Payer: United Healthcare Commercial |
$1,311.63
|
|
|
HC Z COCR 12/14 28 FEM HD +0
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC Z COCR 12/14 28 FEM HD +0
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.90
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Centivo All Commercial |
$1,173.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$1,173.00
|
| Rate for Payer: Lucent All Commercial |
$1,173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$759.00
|
|
|
HC Z COCR 12/14 28 FEM HD +3.5
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
|
HC Z COCR 12/14 28 FEM HD +3.5
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,941.20
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$759.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,320.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,437.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$872.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$834.90
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Centivo All Commercial |
$1,173.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Humana Medicare |
$1,173.00
|
| Rate for Payer: Lucent All Commercial |
$1,173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$897.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
| Rate for Payer: United Healthcare Medicare |
$759.00
|
|
|
HC Z COCR 12/14 28 FEM HD +7
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,426.00
|
| Rate for Payer: Cigna All Commercial |
$1,984.90
|
| Rate for Payer: CORVEL All Commercial |
$2,139.00
|
| Rate for Payer: Coventry All Commercial |
$2,024.00
|
| Rate for Payer: Encore All Commercial |
$2,117.15
|
| Rate for Payer: Frontpath All Commercial |
$2,116.00
|
| Rate for Payer: Humana ChoiceCare |
$1,986.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,070.00
|
| Rate for Payer: PHCS All Commercial |
$1,725.00
|
| Rate for Payer: PHP All Commercial |
$1,744.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,775.60
|
| Rate for Payer: Signature Care EPO |
$1,909.00
|
| Rate for Payer: Signature Care PPO |
$2,024.00
|
| Rate for Payer: United Healthcare Commercial |
$1,812.40
|
|
