|
HC Z COCR 36 FEM HD +7
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605387
|
|
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 40 FEM HD +0
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605389
|
|
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 40 FEM HD +0
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605389
|
|
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 40 FEM HD +10.5
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605392
|
|
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 40 FEM HD +10.5
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605392
|
|
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 40 FEM HD +12
|
Facility
IP
|
$1,821.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,366.20 |
| Max. Negotiated Rate |
$1,694.09 |
| Rate for Payer: Aetna Commercial |
$1,573.86
|
| Rate for Payer: Cash Price |
$1,129.39
|
| Rate for Payer: Cigna All Commercial |
$1,572.04
|
| Rate for Payer: CORVEL All Commercial |
$1,694.09
|
| Rate for Payer: Coventry All Commercial |
$1,603.01
|
| Rate for Payer: Encore All Commercial |
$1,676.78
|
| Rate for Payer: Frontpath All Commercial |
$1,675.87
|
| Rate for Payer: Humana ChoiceCare |
$1,573.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,639.44
|
| Rate for Payer: PHCS All Commercial |
$1,366.20
|
| Rate for Payer: PHP All Commercial |
$1,381.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,406.28
|
| Rate for Payer: Signature Care EPO |
$1,511.93
|
| Rate for Payer: Signature Care PPO |
$1,603.01
|
| Rate for Payer: United Healthcare Commercial |
$1,435.42
|
|
|
HC Z COCR 40 FEM HD +12
|
Facility
OP
|
$1,821.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,694.09 |
| Rate for Payer: Aetna Commercial |
$1,537.43
|
| Rate for Payer: Aetna Medicare |
$601.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$601.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,046.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,138.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$691.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$661.24
|
| Rate for Payer: Cash Price |
$1,129.39
|
| Rate for Payer: Cash Price |
$1,129.39
|
| Rate for Payer: Centivo All Commercial |
$929.02
|
| Rate for Payer: Cigna All Commercial |
$1,572.04
|
| Rate for Payer: CORVEL All Commercial |
$1,694.09
|
| Rate for Payer: Coventry All Commercial |
$1,603.01
|
| Rate for Payer: Encore All Commercial |
$1,676.78
|
| Rate for Payer: Frontpath All Commercial |
$1,675.87
|
| Rate for Payer: Humana ChoiceCare |
$1,573.32
|
| Rate for Payer: Humana Medicare |
$929.02
|
| Rate for Payer: Lucent All Commercial |
$929.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,639.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,366.20
|
| Rate for Payer: PHP All Commercial |
$1,381.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$710.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,406.28
|
| Rate for Payer: Signature Care EPO |
$1,511.93
|
| Rate for Payer: Signature Care PPO |
$1,603.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,548.36
|
| Rate for Payer: United Healthcare Commercial |
$1,435.42
|
| Rate for Payer: United Healthcare Medicare |
$601.13
|
|
|
HC Z COCR 40 FEM HD +3.5
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605390
|
|
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 40 FEM HD +3.5
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605390
|
|
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 40 FEM HD -3.5
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605388
|
|
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 40 FEM HD -3.5
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605388
|
|
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 40 FEM HD +6
|
Facility
OP
|
$1,821.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,694.09 |
| Rate for Payer: Aetna Commercial |
$1,537.43
|
| Rate for Payer: Aetna Medicare |
$601.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$601.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,046.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,138.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$691.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$661.24
|
| Rate for Payer: Cash Price |
$1,129.39
|
| Rate for Payer: Cash Price |
$1,129.39
|
| Rate for Payer: Centivo All Commercial |
$929.02
|
| Rate for Payer: Cigna All Commercial |
$1,572.04
|
| Rate for Payer: CORVEL All Commercial |
$1,694.09
|
| Rate for Payer: Coventry All Commercial |
$1,603.01
|
| Rate for Payer: Encore All Commercial |
$1,676.78
|
| Rate for Payer: Frontpath All Commercial |
$1,675.87
|
| Rate for Payer: Humana ChoiceCare |
$1,573.32
|
| Rate for Payer: Humana Medicare |
$929.02
|
| Rate for Payer: Lucent All Commercial |
$929.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,639.44
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,366.20
|
| Rate for Payer: PHP All Commercial |
$1,381.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$710.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,406.28
|
| Rate for Payer: Signature Care EPO |
$1,511.93
|
| Rate for Payer: Signature Care PPO |
$1,603.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,548.36
|
| Rate for Payer: United Healthcare Commercial |
$1,435.42
|
| Rate for Payer: United Healthcare Medicare |
$601.13
|
|
|
HC Z COCR 40 FEM HD +6
|
Facility
IP
|
$1,821.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,366.20 |
| Max. Negotiated Rate |
$1,694.09 |
| Rate for Payer: Aetna Commercial |
$1,573.86
|
| Rate for Payer: Cash Price |
$1,129.39
|
| Rate for Payer: Cigna All Commercial |
$1,572.04
|
| Rate for Payer: CORVEL All Commercial |
$1,694.09
|
| Rate for Payer: Coventry All Commercial |
$1,603.01
|
| Rate for Payer: Encore All Commercial |
$1,676.78
|
| Rate for Payer: Frontpath All Commercial |
$1,675.87
|
| Rate for Payer: Humana ChoiceCare |
$1,573.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,639.44
|
| Rate for Payer: PHCS All Commercial |
$1,366.20
|
| Rate for Payer: PHP All Commercial |
$1,381.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,406.28
|
| Rate for Payer: Signature Care EPO |
$1,511.93
|
| Rate for Payer: Signature Care PPO |
$1,603.01
|
| Rate for Payer: United Healthcare Commercial |
$1,435.42
|
|
|
HC Z COCR 40 FEM HD +7.0
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605391
|
|
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 40 FEM HD +7.0
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605391
|
|
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 K-WIRE 0.9, 9.5
|
Facility
OP
|
$185.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$156.27
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.21
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Centivo All Commercial |
$94.43
|
| Rate for Payer: Cigna All Commercial |
$159.78
|
| Rate for Payer: CORVEL All Commercial |
$172.19
|
| Rate for Payer: Coventry All Commercial |
$162.93
|
| Rate for Payer: Encore All Commercial |
$170.43
|
| Rate for Payer: Frontpath All Commercial |
$170.34
|
| Rate for Payer: Humana ChoiceCare |
$159.91
|
| Rate for Payer: Humana Medicare |
$94.43
|
| Rate for Payer: Lucent All Commercial |
$94.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$138.86
|
| Rate for Payer: PHP All Commercial |
$140.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.21
|
| Rate for Payer: Sagamore Health Network All Products |
$142.94
|
| Rate for Payer: Signature Care EPO |
$153.67
|
| Rate for Payer: Signature Care PPO |
$162.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157.38
|
| Rate for Payer: United Healthcare Commercial |
$145.90
|
| Rate for Payer: United Healthcare Medicare |
$61.10
|
|
|
HC Z COCR K-WIRE 0.9, 9.5
|
Facility
IP
|
$185.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.86 |
| Max. Negotiated Rate |
$172.19 |
| Rate for Payer: Aetna Commercial |
$159.97
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Cigna All Commercial |
$159.78
|
| Rate for Payer: CORVEL All Commercial |
$172.19
|
| Rate for Payer: Coventry All Commercial |
$162.93
|
| Rate for Payer: Encore All Commercial |
$170.43
|
| Rate for Payer: Frontpath All Commercial |
$170.34
|
| Rate for Payer: Humana ChoiceCare |
$159.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.64
|
| Rate for Payer: PHCS All Commercial |
$138.86
|
| Rate for Payer: PHP All Commercial |
$140.42
|
| Rate for Payer: Sagamore Health Network All Products |
$142.94
|
| Rate for Payer: Signature Care EPO |
$153.67
|
| Rate for Payer: Signature Care PPO |
$162.93
|
| Rate for Payer: United Healthcare Commercial |
$145.90
|
|
|
HC Z COCR K-WIRE 1.1 105
|
Facility
IP
|
$185.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.86 |
| Max. Negotiated Rate |
$172.19 |
| Rate for Payer: Aetna Commercial |
$159.97
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Cigna All Commercial |
$159.78
|
| Rate for Payer: CORVEL All Commercial |
$172.19
|
| Rate for Payer: Coventry All Commercial |
$162.93
|
| Rate for Payer: Encore All Commercial |
$170.43
|
| Rate for Payer: Frontpath All Commercial |
$170.34
|
| Rate for Payer: Humana ChoiceCare |
$159.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.64
|
| Rate for Payer: PHCS All Commercial |
$138.86
|
| Rate for Payer: PHP All Commercial |
$140.42
|
| Rate for Payer: Sagamore Health Network All Products |
$142.94
|
| Rate for Payer: Signature Care EPO |
$153.67
|
| Rate for Payer: Signature Care PPO |
$162.93
|
| Rate for Payer: United Healthcare Commercial |
$145.90
|
|
|
HC Z COCR K-WIRE 1.1 105
|
Facility
OP
|
$185.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$156.27
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.21
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Centivo All Commercial |
$94.43
|
| Rate for Payer: Cigna All Commercial |
$159.78
|
| Rate for Payer: CORVEL All Commercial |
$172.19
|
| Rate for Payer: Coventry All Commercial |
$162.93
|
| Rate for Payer: Encore All Commercial |
$170.43
|
| Rate for Payer: Frontpath All Commercial |
$170.34
|
| Rate for Payer: Humana ChoiceCare |
$159.91
|
| Rate for Payer: Humana Medicare |
$94.43
|
| Rate for Payer: Lucent All Commercial |
$94.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$138.86
|
| Rate for Payer: PHP All Commercial |
$140.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.21
|
| Rate for Payer: Sagamore Health Network All Products |
$142.94
|
| Rate for Payer: Signature Care EPO |
$153.67
|
| Rate for Payer: Signature Care PPO |
$162.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157.38
|
| Rate for Payer: United Healthcare Commercial |
$145.90
|
| Rate for Payer: United Healthcare Medicare |
$61.10
|
|
|
HC Z COCR K-WIRE 1.4, 127
|
Facility
OP
|
$185.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$156.27
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.21
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Centivo All Commercial |
$94.43
|
| Rate for Payer: Cigna All Commercial |
$159.78
|
| Rate for Payer: CORVEL All Commercial |
$172.19
|
| Rate for Payer: Coventry All Commercial |
$162.93
|
| Rate for Payer: Encore All Commercial |
$170.43
|
| Rate for Payer: Frontpath All Commercial |
$170.34
|
| Rate for Payer: Humana ChoiceCare |
$159.91
|
| Rate for Payer: Humana Medicare |
$94.43
|
| Rate for Payer: Lucent All Commercial |
$94.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$138.86
|
| Rate for Payer: PHP All Commercial |
$140.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.21
|
| Rate for Payer: Sagamore Health Network All Products |
$142.94
|
| Rate for Payer: Signature Care EPO |
$153.67
|
| Rate for Payer: Signature Care PPO |
$162.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157.38
|
| Rate for Payer: United Healthcare Commercial |
$145.90
|
| Rate for Payer: United Healthcare Medicare |
$61.10
|
|
|
HC Z COCR K-WIRE 1.4, 127
|
Facility
IP
|
$185.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.86 |
| Max. Negotiated Rate |
$172.19 |
| Rate for Payer: Aetna Commercial |
$159.97
|
| Rate for Payer: Cash Price |
$114.79
|
| Rate for Payer: Cigna All Commercial |
$159.78
|
| Rate for Payer: CORVEL All Commercial |
$172.19
|
| Rate for Payer: Coventry All Commercial |
$162.93
|
| Rate for Payer: Encore All Commercial |
$170.43
|
| Rate for Payer: Frontpath All Commercial |
$170.34
|
| Rate for Payer: Humana ChoiceCare |
$159.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.64
|
| Rate for Payer: PHCS All Commercial |
$138.86
|
| Rate for Payer: PHP All Commercial |
$140.42
|
| Rate for Payer: Sagamore Health Network All Products |
$142.94
|
| Rate for Payer: Signature Care EPO |
$153.67
|
| Rate for Payer: Signature Care PPO |
$162.93
|
| Rate for Payer: United Healthcare Commercial |
$145.90
|
|
|
HC Z COCR MOD HD 28 +3NECK T1
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603597
|
|
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 MOD HD 28 +3NECK T1
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603597
|
|
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 MOD HD 28 +6 NECK T1
|
Facility
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603497
|
|
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 MOD HD 28 +6 NECK T1
|
Facility
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603497
|
|
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
|
|
