HC Z COCR MOD HD 28 -6NECK TI
|
Facility
IP
|
$2,300.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41603730
|
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 -6NECK TI
|
Facility
OP
|
$2,300.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41603730
|
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 +9 NECK T1
|
Facility
OP
|
$2,300.00
|
|
Service Code
|
CPT C1713
|
Hospital Charge Code |
41603591
|
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 +9 NECK T1
|
Facility
IP
|
$2,300.00
|
|
Service Code
|
CPT C1713
|
Hospital Charge Code |
41603591
|
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 36 -6NECK
|
Facility
OP
|
$2,300.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41606131
|
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 36 -6NECK
|
Facility
IP
|
$2,300.00
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41606131
|
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 36 STD
|
Facility
IP
|
$2,300.00
|
|
Service Code
|
CPT C1713
|
Hospital Charge Code |
41606109
|
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 36 STD
|
Facility
OP
|
$2,300.00
|
|
Service Code
|
CPT C1713
|
Hospital Charge Code |
41606109
|
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 COMP AUG ROT BUIDE/BONE LT
|
Facility
OP
|
$4,104.00
|
|
Hospital Charge Code |
41608317
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$121.68 |
Max. Negotiated Rate |
$3,816.72 |
Rate for Payer: Aetna Commercial |
$3,463.78
|
Rate for Payer: Aetna Medicare |
$1,354.32
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,354.32
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,356.93
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,565.41
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,557.47
|
Rate for Payer: CareSource Indiana of IN Medicare |
$1,489.75
|
Rate for Payer: Cash Price |
$2,544.48
|
Rate for Payer: Cash Price |
$2,544.48
|
Rate for Payer: Centivo All Commercial |
$2,093.04
|
Rate for Payer: Cigna All Commercial |
$3,541.75
|
Rate for Payer: CORVEL All Commercial |
$3,816.72
|
Rate for Payer: Coventry All Commercial |
$3,611.52
|
Rate for Payer: Encore All Commercial |
$3,777.73
|
Rate for Payer: Frontpath All Commercial |
$3,775.68
|
Rate for Payer: Humana ChoiceCare |
$3,544.62
|
Rate for Payer: Humana Medicare |
$2,093.04
|
Rate for Payer: Lucent All Commercial |
$2,093.04
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,693.60
|
Rate for Payer: Managed Health Services Medicaid |
$121.68
|
Rate for Payer: MDWise Medicaid |
$121.68
|
Rate for Payer: PHCS All Commercial |
$3,078.00
|
Rate for Payer: PHP All Commercial |
$3,112.47
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$1,600.56
|
Rate for Payer: Sagamore Health Network All Products |
$3,168.29
|
Rate for Payer: Signature Care EPO |
$3,406.32
|
Rate for Payer: Signature Care PPO |
$3,611.52
|
Rate for Payer: Three Rivers Preferred All Commercial |
$3,488.40
|
Rate for Payer: United Healthcare Commercial |
$3,233.95
|
Rate for Payer: United Healthcare Medicare |
$1,354.32
|
|
HC Z COMP AUG ROT BUIDE/BONE LT
|
Facility
IP
|
$4,104.00
|
|
Hospital Charge Code |
41608317
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$3,078.00 |
Max. Negotiated Rate |
$3,816.72 |
Rate for Payer: Cigna All Commercial |
$3,541.75
|
Rate for Payer: Aetna Commercial |
$3,545.86
|
Rate for Payer: Cash Price |
$2,544.48
|
Rate for Payer: CORVEL All Commercial |
$3,816.72
|
Rate for Payer: Coventry All Commercial |
$3,611.52
|
Rate for Payer: Encore All Commercial |
$3,777.73
|
Rate for Payer: Frontpath All Commercial |
$3,775.68
|
Rate for Payer: Humana ChoiceCare |
$3,544.62
|
Rate for Payer: Lutheran Preferred All Commercial |
$3,693.60
|
Rate for Payer: PHCS All Commercial |
$3,078.00
|
Rate for Payer: PHP All Commercial |
$3,112.47
|
Rate for Payer: Sagamore Health Network All Products |
$3,168.29
|
Rate for Payer: Signature Care EPO |
$3,406.32
|
Rate for Payer: Signature Care PPO |
$3,611.52
|
Rate for Payer: United Healthcare Commercial |
$3,233.95
|
|
HC Z COMP STEM 10MM MINI
|
Facility
OP
|
$14,069.38
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605602
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$13,084.52 |
Rate for Payer: Aetna Commercial |
$11,874.56
|
Rate for Payer: Aetna Medicare |
$4,642.90
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,642.90
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,080.04
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,794.77
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,339.33
|
Rate for Payer: CareSource Indiana of IN Medicare |
$5,107.18
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Centivo All Commercial |
$7,175.38
|
Rate for Payer: Cigna All Commercial |
$12,141.87
|
Rate for Payer: CORVEL All Commercial |
$13,084.52
|
Rate for Payer: Coventry All Commercial |
$12,381.05
|
Rate for Payer: Encore All Commercial |
$12,950.86
|
Rate for Payer: Frontpath All Commercial |
$12,943.83
|
Rate for Payer: Humana ChoiceCare |
$12,151.72
|
Rate for Payer: Humana Medicare |
$7,175.38
|
Rate for Payer: Lucent All Commercial |
$7,175.38
|
Rate for Payer: Lutheran Preferred All Commercial |
$12,662.44
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$10,552.04
|
Rate for Payer: PHP All Commercial |
$10,670.22
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$5,487.06
|
Rate for Payer: Sagamore Health Network All Products |
$10,861.56
|
Rate for Payer: Signature Care EPO |
$11,677.59
|
Rate for Payer: Signature Care PPO |
$12,381.05
|
Rate for Payer: Three Rivers Preferred All Commercial |
$11,958.97
|
Rate for Payer: United Healthcare Commercial |
$11,086.67
|
Rate for Payer: United Healthcare Medicare |
$4,642.90
|
|
HC Z COMP STEM 10MM MINI
|
Facility
IP
|
$14,069.38
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605602
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$10,552.04 |
Max. Negotiated Rate |
$13,084.52 |
Rate for Payer: Aetna Commercial |
$12,155.94
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Cigna All Commercial |
$12,141.87
|
Rate for Payer: CORVEL All Commercial |
$13,084.52
|
Rate for Payer: Coventry All Commercial |
$12,381.05
|
Rate for Payer: Encore All Commercial |
$12,950.86
|
Rate for Payer: Frontpath All Commercial |
$12,943.83
|
Rate for Payer: Humana ChoiceCare |
$12,151.72
|
Rate for Payer: Lutheran Preferred All Commercial |
$12,662.44
|
Rate for Payer: PHCS All Commercial |
$10,552.04
|
Rate for Payer: PHP All Commercial |
$10,670.22
|
Rate for Payer: Sagamore Health Network All Products |
$10,861.56
|
Rate for Payer: Signature Care EPO |
$11,677.59
|
Rate for Payer: Signature Care PPO |
$12,381.05
|
Rate for Payer: United Healthcare Commercial |
$11,086.67
|
|
HC Z COMP STEM 10MM STD
|
Facility
IP
|
$12,598.85
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605588
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9,449.14 |
Max. Negotiated Rate |
$11,716.93 |
Rate for Payer: Aetna Commercial |
$10,885.41
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Cigna All Commercial |
$10,872.81
|
Rate for Payer: CORVEL All Commercial |
$11,716.93
|
Rate for Payer: Coventry All Commercial |
$11,086.99
|
Rate for Payer: Encore All Commercial |
$11,597.24
|
Rate for Payer: Frontpath All Commercial |
$11,590.94
|
Rate for Payer: Humana ChoiceCare |
$10,881.63
|
Rate for Payer: Lutheran Preferred All Commercial |
$11,338.96
|
Rate for Payer: PHCS All Commercial |
$9,449.14
|
Rate for Payer: PHP All Commercial |
$9,554.97
|
Rate for Payer: Sagamore Health Network All Products |
$9,726.31
|
Rate for Payer: Signature Care EPO |
$10,457.05
|
Rate for Payer: Signature Care PPO |
$11,086.99
|
Rate for Payer: United Healthcare Commercial |
$9,927.89
|
|
HC Z COMP STEM 10MM STD
|
Facility
OP
|
$12,598.85
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605588
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$11,716.93 |
Rate for Payer: Aetna Commercial |
$10,633.43
|
Rate for Payer: Aetna Medicare |
$4,157.62
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,157.62
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,235.52
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,875.54
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,781.26
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,573.38
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Centivo All Commercial |
$6,425.41
|
Rate for Payer: Cigna All Commercial |
$10,872.81
|
Rate for Payer: CORVEL All Commercial |
$11,716.93
|
Rate for Payer: Coventry All Commercial |
$11,086.99
|
Rate for Payer: Encore All Commercial |
$11,597.24
|
Rate for Payer: Frontpath All Commercial |
$11,590.94
|
Rate for Payer: Humana ChoiceCare |
$10,881.63
|
Rate for Payer: Humana Medicare |
$6,425.41
|
Rate for Payer: Lucent All Commercial |
$6,425.41
|
Rate for Payer: Lutheran Preferred All Commercial |
$11,338.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$9,449.14
|
Rate for Payer: PHP All Commercial |
$9,554.97
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,913.55
|
Rate for Payer: Sagamore Health Network All Products |
$9,726.31
|
Rate for Payer: Signature Care EPO |
$10,457.05
|
Rate for Payer: Signature Care PPO |
$11,086.99
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,709.02
|
Rate for Payer: United Healthcare Commercial |
$9,927.89
|
Rate for Payer: United Healthcare Medicare |
$4,157.62
|
|
HC Z COMP STEM 11MM MINI
|
Facility
OP
|
$14,069.38
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605603
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$13,084.52 |
Rate for Payer: Aetna Commercial |
$11,874.56
|
Rate for Payer: Aetna Medicare |
$4,642.90
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,642.90
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,080.04
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,794.77
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,339.33
|
Rate for Payer: CareSource Indiana of IN Medicare |
$5,107.18
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Centivo All Commercial |
$7,175.38
|
Rate for Payer: Cigna All Commercial |
$12,141.87
|
Rate for Payer: CORVEL All Commercial |
$13,084.52
|
Rate for Payer: Coventry All Commercial |
$12,381.05
|
Rate for Payer: Encore All Commercial |
$12,950.86
|
Rate for Payer: Frontpath All Commercial |
$12,943.83
|
Rate for Payer: Humana ChoiceCare |
$12,151.72
|
Rate for Payer: Humana Medicare |
$7,175.38
|
Rate for Payer: Lucent All Commercial |
$7,175.38
|
Rate for Payer: Lutheran Preferred All Commercial |
$12,662.44
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$10,552.04
|
Rate for Payer: PHP All Commercial |
$10,670.22
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$5,487.06
|
Rate for Payer: Sagamore Health Network All Products |
$10,861.56
|
Rate for Payer: Signature Care EPO |
$11,677.59
|
Rate for Payer: Signature Care PPO |
$12,381.05
|
Rate for Payer: Three Rivers Preferred All Commercial |
$11,958.97
|
Rate for Payer: United Healthcare Commercial |
$11,086.67
|
Rate for Payer: United Healthcare Medicare |
$4,642.90
|
|
HC Z COMP STEM 11MM MINI
|
Facility
IP
|
$14,069.38
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605603
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$10,552.04 |
Max. Negotiated Rate |
$13,084.52 |
Rate for Payer: Aetna Commercial |
$12,155.94
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Cigna All Commercial |
$12,141.87
|
Rate for Payer: CORVEL All Commercial |
$13,084.52
|
Rate for Payer: Coventry All Commercial |
$12,381.05
|
Rate for Payer: Encore All Commercial |
$12,950.86
|
Rate for Payer: Frontpath All Commercial |
$12,943.83
|
Rate for Payer: Humana ChoiceCare |
$12,151.72
|
Rate for Payer: Lutheran Preferred All Commercial |
$12,662.44
|
Rate for Payer: PHCS All Commercial |
$10,552.04
|
Rate for Payer: PHP All Commercial |
$10,670.22
|
Rate for Payer: Sagamore Health Network All Products |
$10,861.56
|
Rate for Payer: Signature Care EPO |
$11,677.59
|
Rate for Payer: Signature Care PPO |
$12,381.05
|
Rate for Payer: United Healthcare Commercial |
$11,086.67
|
|
HC Z COMP STEM 11MM STD
|
Facility
IP
|
$12,598.85
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605589
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9,449.14 |
Max. Negotiated Rate |
$11,716.93 |
Rate for Payer: Aetna Commercial |
$10,885.41
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Cigna All Commercial |
$10,872.81
|
Rate for Payer: CORVEL All Commercial |
$11,716.93
|
Rate for Payer: Coventry All Commercial |
$11,086.99
|
Rate for Payer: Encore All Commercial |
$11,597.24
|
Rate for Payer: Frontpath All Commercial |
$11,590.94
|
Rate for Payer: Humana ChoiceCare |
$10,881.63
|
Rate for Payer: Lutheran Preferred All Commercial |
$11,338.96
|
Rate for Payer: PHCS All Commercial |
$9,449.14
|
Rate for Payer: PHP All Commercial |
$9,554.97
|
Rate for Payer: Sagamore Health Network All Products |
$9,726.31
|
Rate for Payer: Signature Care EPO |
$10,457.05
|
Rate for Payer: Signature Care PPO |
$11,086.99
|
Rate for Payer: United Healthcare Commercial |
$9,927.89
|
|
HC Z COMP STEM 11MM STD
|
Facility
OP
|
$12,598.85
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605589
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$11,716.93 |
Rate for Payer: Aetna Commercial |
$10,633.43
|
Rate for Payer: Aetna Medicare |
$4,157.62
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,157.62
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,235.52
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,875.54
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,781.26
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,573.38
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Centivo All Commercial |
$6,425.41
|
Rate for Payer: Cigna All Commercial |
$10,872.81
|
Rate for Payer: CORVEL All Commercial |
$11,716.93
|
Rate for Payer: Coventry All Commercial |
$11,086.99
|
Rate for Payer: Encore All Commercial |
$11,597.24
|
Rate for Payer: Frontpath All Commercial |
$11,590.94
|
Rate for Payer: Humana ChoiceCare |
$10,881.63
|
Rate for Payer: Humana Medicare |
$6,425.41
|
Rate for Payer: Lucent All Commercial |
$6,425.41
|
Rate for Payer: Lutheran Preferred All Commercial |
$11,338.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$9,449.14
|
Rate for Payer: PHP All Commercial |
$9,554.97
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,913.55
|
Rate for Payer: Sagamore Health Network All Products |
$9,726.31
|
Rate for Payer: Signature Care EPO |
$10,457.05
|
Rate for Payer: Signature Care PPO |
$11,086.99
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,709.02
|
Rate for Payer: United Healthcare Commercial |
$9,927.89
|
Rate for Payer: United Healthcare Medicare |
$4,157.62
|
|
HC Z COMP STEM 12MM MINI
|
Facility
IP
|
$14,069.38
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605604
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$10,552.04 |
Max. Negotiated Rate |
$13,084.52 |
Rate for Payer: Aetna Commercial |
$12,155.94
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Cigna All Commercial |
$12,141.87
|
Rate for Payer: CORVEL All Commercial |
$13,084.52
|
Rate for Payer: Coventry All Commercial |
$12,381.05
|
Rate for Payer: Encore All Commercial |
$12,950.86
|
Rate for Payer: Frontpath All Commercial |
$12,943.83
|
Rate for Payer: Humana ChoiceCare |
$12,151.72
|
Rate for Payer: Lutheran Preferred All Commercial |
$12,662.44
|
Rate for Payer: PHCS All Commercial |
$10,552.04
|
Rate for Payer: PHP All Commercial |
$10,670.22
|
Rate for Payer: Sagamore Health Network All Products |
$10,861.56
|
Rate for Payer: Signature Care EPO |
$11,677.59
|
Rate for Payer: Signature Care PPO |
$12,381.05
|
Rate for Payer: United Healthcare Commercial |
$11,086.67
|
|
HC Z COMP STEM 12MM MINI
|
Facility
OP
|
$14,069.38
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605604
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$13,084.52 |
Rate for Payer: Aetna Commercial |
$11,874.56
|
Rate for Payer: Aetna Medicare |
$4,642.90
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,642.90
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,080.04
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,794.77
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,339.33
|
Rate for Payer: CareSource Indiana of IN Medicare |
$5,107.18
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Centivo All Commercial |
$7,175.38
|
Rate for Payer: Cigna All Commercial |
$12,141.87
|
Rate for Payer: CORVEL All Commercial |
$13,084.52
|
Rate for Payer: Coventry All Commercial |
$12,381.05
|
Rate for Payer: Encore All Commercial |
$12,950.86
|
Rate for Payer: Frontpath All Commercial |
$12,943.83
|
Rate for Payer: Humana ChoiceCare |
$12,151.72
|
Rate for Payer: Humana Medicare |
$7,175.38
|
Rate for Payer: Lucent All Commercial |
$7,175.38
|
Rate for Payer: Lutheran Preferred All Commercial |
$12,662.44
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$10,552.04
|
Rate for Payer: PHP All Commercial |
$10,670.22
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$5,487.06
|
Rate for Payer: Sagamore Health Network All Products |
$10,861.56
|
Rate for Payer: Signature Care EPO |
$11,677.59
|
Rate for Payer: Signature Care PPO |
$12,381.05
|
Rate for Payer: Three Rivers Preferred All Commercial |
$11,958.97
|
Rate for Payer: United Healthcare Commercial |
$11,086.67
|
Rate for Payer: United Healthcare Medicare |
$4,642.90
|
|
HC Z COMP STEM 12MM STD
|
Facility
OP
|
$12,598.85
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605590
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$11,716.93 |
Rate for Payer: Aetna Commercial |
$10,633.43
|
Rate for Payer: Aetna Medicare |
$4,157.62
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,157.62
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7,235.52
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,875.54
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,781.26
|
Rate for Payer: CareSource Indiana of IN Medicare |
$4,573.38
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Centivo All Commercial |
$6,425.41
|
Rate for Payer: Cigna All Commercial |
$10,872.81
|
Rate for Payer: CORVEL All Commercial |
$11,716.93
|
Rate for Payer: Coventry All Commercial |
$11,086.99
|
Rate for Payer: Encore All Commercial |
$11,597.24
|
Rate for Payer: Frontpath All Commercial |
$11,590.94
|
Rate for Payer: Humana ChoiceCare |
$10,881.63
|
Rate for Payer: Humana Medicare |
$6,425.41
|
Rate for Payer: Lucent All Commercial |
$6,425.41
|
Rate for Payer: Lutheran Preferred All Commercial |
$11,338.96
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$9,449.14
|
Rate for Payer: PHP All Commercial |
$9,554.97
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$4,913.55
|
Rate for Payer: Sagamore Health Network All Products |
$9,726.31
|
Rate for Payer: Signature Care EPO |
$10,457.05
|
Rate for Payer: Signature Care PPO |
$11,086.99
|
Rate for Payer: Three Rivers Preferred All Commercial |
$10,709.02
|
Rate for Payer: United Healthcare Commercial |
$9,927.89
|
Rate for Payer: United Healthcare Medicare |
$4,157.62
|
|
HC Z COMP STEM 12MM STD
|
Facility
IP
|
$12,598.85
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605590
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9,449.14 |
Max. Negotiated Rate |
$11,716.93 |
Rate for Payer: Aetna Commercial |
$10,885.41
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Cigna All Commercial |
$10,872.81
|
Rate for Payer: CORVEL All Commercial |
$11,716.93
|
Rate for Payer: Coventry All Commercial |
$11,086.99
|
Rate for Payer: Encore All Commercial |
$11,597.24
|
Rate for Payer: Frontpath All Commercial |
$11,590.94
|
Rate for Payer: Humana ChoiceCare |
$10,881.63
|
Rate for Payer: Lutheran Preferred All Commercial |
$11,338.96
|
Rate for Payer: PHCS All Commercial |
$9,449.14
|
Rate for Payer: PHP All Commercial |
$9,554.97
|
Rate for Payer: Sagamore Health Network All Products |
$9,726.31
|
Rate for Payer: Signature Care EPO |
$10,457.05
|
Rate for Payer: Signature Care PPO |
$11,086.99
|
Rate for Payer: United Healthcare Commercial |
$9,927.89
|
|
HC Z COMP STEM 13MM MINI
|
Facility
OP
|
$14,069.38
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605605
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$524.16 |
Max. Negotiated Rate |
$13,084.52 |
Rate for Payer: Aetna Commercial |
$11,874.56
|
Rate for Payer: Aetna Medicare |
$4,642.90
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$4,642.90
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,080.04
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,794.77
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,339.33
|
Rate for Payer: CareSource Indiana of IN Medicare |
$5,107.18
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Centivo All Commercial |
$7,175.38
|
Rate for Payer: Cigna All Commercial |
$12,141.87
|
Rate for Payer: CORVEL All Commercial |
$13,084.52
|
Rate for Payer: Coventry All Commercial |
$12,381.05
|
Rate for Payer: Encore All Commercial |
$12,950.86
|
Rate for Payer: Frontpath All Commercial |
$12,943.83
|
Rate for Payer: Humana ChoiceCare |
$12,151.72
|
Rate for Payer: Humana Medicare |
$7,175.38
|
Rate for Payer: Lucent All Commercial |
$7,175.38
|
Rate for Payer: Lutheran Preferred All Commercial |
$12,662.44
|
Rate for Payer: Managed Health Services Medicaid |
$524.16
|
Rate for Payer: MDWise Medicaid |
$524.16
|
Rate for Payer: PHCS All Commercial |
$10,552.04
|
Rate for Payer: PHP All Commercial |
$10,670.22
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$5,487.06
|
Rate for Payer: Sagamore Health Network All Products |
$10,861.56
|
Rate for Payer: Signature Care EPO |
$11,677.59
|
Rate for Payer: Signature Care PPO |
$12,381.05
|
Rate for Payer: Three Rivers Preferred All Commercial |
$11,958.97
|
Rate for Payer: United Healthcare Commercial |
$11,086.67
|
Rate for Payer: United Healthcare Medicare |
$4,642.90
|
|
HC Z COMP STEM 13MM MINI
|
Facility
IP
|
$14,069.38
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605605
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$10,552.04 |
Max. Negotiated Rate |
$13,084.52 |
Rate for Payer: Aetna Commercial |
$12,155.94
|
Rate for Payer: Cash Price |
$8,723.02
|
Rate for Payer: Cigna All Commercial |
$12,141.87
|
Rate for Payer: CORVEL All Commercial |
$13,084.52
|
Rate for Payer: Coventry All Commercial |
$12,381.05
|
Rate for Payer: Encore All Commercial |
$12,950.86
|
Rate for Payer: Frontpath All Commercial |
$12,943.83
|
Rate for Payer: Humana ChoiceCare |
$12,151.72
|
Rate for Payer: Lutheran Preferred All Commercial |
$12,662.44
|
Rate for Payer: PHCS All Commercial |
$10,552.04
|
Rate for Payer: PHP All Commercial |
$10,670.22
|
Rate for Payer: Sagamore Health Network All Products |
$10,861.56
|
Rate for Payer: Signature Care EPO |
$11,677.59
|
Rate for Payer: Signature Care PPO |
$12,381.05
|
Rate for Payer: United Healthcare Commercial |
$11,086.67
|
|
HC Z COMP STEM 13MM STD
|
Facility
IP
|
$12,598.85
|
|
Service Code
|
CPT C1776
|
Hospital Charge Code |
41605591
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9,449.14 |
Max. Negotiated Rate |
$11,716.93 |
Rate for Payer: Aetna Commercial |
$10,885.41
|
Rate for Payer: Cash Price |
$7,811.29
|
Rate for Payer: Cigna All Commercial |
$10,872.81
|
Rate for Payer: CORVEL All Commercial |
$11,716.93
|
Rate for Payer: Coventry All Commercial |
$11,086.99
|
Rate for Payer: Encore All Commercial |
$11,597.24
|
Rate for Payer: Frontpath All Commercial |
$11,590.94
|
Rate for Payer: Humana ChoiceCare |
$10,881.63
|
Rate for Payer: Lutheran Preferred All Commercial |
$11,338.96
|
Rate for Payer: PHCS All Commercial |
$9,449.14
|
Rate for Payer: PHP All Commercial |
$9,554.97
|
Rate for Payer: Sagamore Health Network All Products |
$9,726.31
|
Rate for Payer: Signature Care EPO |
$10,457.05
|
Rate for Payer: Signature Care PPO |
$11,086.99
|
Rate for Payer: United Healthcare Commercial |
$9,927.89
|
|