|
HC Z DM BRG 28X46 VIV-E G
|
Facility
IP
|
$5,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,665.60
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
|
|
HC Z DM BRG 28X46 VIV-E G
|
Facility
OP
|
$5,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna Commercial |
$4,557.60
|
| Rate for Payer: Aetna Medicare |
$1,782.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,782.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,101.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,049.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,960.20
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$2,754.00
|
| Rate for Payer: Cigna All Commercial |
$4,660.20
|
| Rate for Payer: CORVEL All Commercial |
$5,022.00
|
| Rate for Payer: Coventry All Commercial |
$4,752.00
|
| Rate for Payer: Encore All Commercial |
$4,970.70
|
| Rate for Payer: Frontpath All Commercial |
$4,968.00
|
| Rate for Payer: Humana ChoiceCare |
$4,663.98
|
| Rate for Payer: Humana Medicare |
$2,754.00
|
| Rate for Payer: Lucent All Commercial |
$2,754.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,860.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,050.00
|
| Rate for Payer: PHP All Commercial |
$4,095.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,106.00
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.80
|
| Rate for Payer: Signature Care EPO |
$4,482.00
|
| Rate for Payer: Signature Care PPO |
$4,752.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,590.00
|
| Rate for Payer: United Healthcare Commercial |
$4,255.20
|
| Rate for Payer: United Healthcare Medicare |
$1,782.00
|
|
|
HC Z DRILL 2.4 2430
|
Facility
OP
|
$815.57
|
|
| Hospital Charge Code |
41606512
|
|
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 DRILL 2.4 2430
|
Facility
IP
|
$815.57
|
|
| Hospital Charge Code |
41606512
|
|
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 DRILL 2.5 STD
|
Facility
IP
|
$699.09
|
|
| Hospital Charge Code |
41606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z DRILL 2.5 STD
|
Facility
OP
|
$699.09
|
|
| Hospital Charge Code |
41606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z DRILL 2.5X245 NCB
|
Facility
OP
|
$722.40
|
|
| Hospital Charge Code |
41608278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$671.83 |
| Rate for Payer: Aetna Commercial |
$609.71
|
| Rate for Payer: Aetna Medicare |
$238.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$238.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$414.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$274.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$262.23
|
| Rate for Payer: Cash Price |
$447.89
|
| Rate for Payer: Cash Price |
$447.89
|
| Rate for Payer: Centivo All Commercial |
$368.42
|
| Rate for Payer: Cigna All Commercial |
$623.43
|
| Rate for Payer: CORVEL All Commercial |
$671.83
|
| Rate for Payer: Coventry All Commercial |
$635.71
|
| Rate for Payer: Encore All Commercial |
$664.97
|
| Rate for Payer: Frontpath All Commercial |
$664.61
|
| Rate for Payer: Humana ChoiceCare |
$623.94
|
| Rate for Payer: Humana Medicare |
$368.42
|
| Rate for Payer: Lucent All Commercial |
$368.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$650.16
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$541.80
|
| Rate for Payer: PHP All Commercial |
$547.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$281.74
|
| Rate for Payer: Sagamore Health Network All Products |
$557.69
|
| Rate for Payer: Signature Care EPO |
$599.59
|
| Rate for Payer: Signature Care PPO |
$635.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$614.04
|
| Rate for Payer: United Healthcare Commercial |
$569.25
|
| Rate for Payer: United Healthcare Medicare |
$238.39
|
|
|
HC Z DRILL 2.5X245 NCB
|
Facility
IP
|
$722.40
|
|
| Hospital Charge Code |
41608278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$541.80 |
| Max. Negotiated Rate |
$671.83 |
| Rate for Payer: Aetna Commercial |
$624.15
|
| Rate for Payer: Cash Price |
$447.89
|
| Rate for Payer: Cigna All Commercial |
$623.43
|
| Rate for Payer: CORVEL All Commercial |
$671.83
|
| Rate for Payer: Coventry All Commercial |
$635.71
|
| Rate for Payer: Encore All Commercial |
$664.97
|
| Rate for Payer: Frontpath All Commercial |
$664.61
|
| Rate for Payer: Humana ChoiceCare |
$623.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$650.16
|
| Rate for Payer: PHCS All Commercial |
$541.80
|
| Rate for Payer: PHP All Commercial |
$547.87
|
| Rate for Payer: Sagamore Health Network All Products |
$557.69
|
| Rate for Payer: Signature Care EPO |
$599.59
|
| Rate for Payer: Signature Care PPO |
$635.71
|
| Rate for Payer: United Healthcare Commercial |
$569.25
|
|
|
HC Z DRILL 2.7 CANN 7127
|
Facility
OP
|
$848.90
|
|
| Hospital Charge Code |
41606636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$789.48 |
| Rate for Payer: Aetna Commercial |
$716.47
|
| Rate for Payer: Aetna Medicare |
$280.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$280.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$487.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.15
|
| Rate for Payer: Cash Price |
$526.32
|
| Rate for Payer: Cash Price |
$526.32
|
| Rate for Payer: Centivo All Commercial |
$432.94
|
| Rate for Payer: Cigna All Commercial |
$732.60
|
| Rate for Payer: CORVEL All Commercial |
$789.48
|
| Rate for Payer: Coventry All Commercial |
$747.03
|
| Rate for Payer: Encore All Commercial |
$781.41
|
| Rate for Payer: Frontpath All Commercial |
$780.99
|
| Rate for Payer: Humana ChoiceCare |
$733.19
|
| Rate for Payer: Humana Medicare |
$432.94
|
| Rate for Payer: Lucent All Commercial |
$432.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$764.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$636.68
|
| Rate for Payer: PHP All Commercial |
$643.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$331.07
|
| Rate for Payer: Sagamore Health Network All Products |
$655.35
|
| Rate for Payer: Signature Care EPO |
$704.59
|
| Rate for Payer: Signature Care PPO |
$747.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.56
|
| Rate for Payer: United Healthcare Commercial |
$668.93
|
| Rate for Payer: United Healthcare Medicare |
$280.14
|
|
|
HC Z DRILL 2.7 CANN 7127
|
Facility
IP
|
$848.90
|
|
| Hospital Charge Code |
41606636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.68 |
| Max. Negotiated Rate |
$789.48 |
| Rate for Payer: Aetna Commercial |
$733.45
|
| Rate for Payer: Cash Price |
$526.32
|
| Rate for Payer: Cigna All Commercial |
$732.60
|
| Rate for Payer: CORVEL All Commercial |
$789.48
|
| Rate for Payer: Coventry All Commercial |
$747.03
|
| Rate for Payer: Encore All Commercial |
$781.41
|
| Rate for Payer: Frontpath All Commercial |
$780.99
|
| Rate for Payer: Humana ChoiceCare |
$733.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$764.01
|
| Rate for Payer: PHCS All Commercial |
$636.68
|
| Rate for Payer: PHP All Commercial |
$643.81
|
| Rate for Payer: Sagamore Health Network All Products |
$655.35
|
| Rate for Payer: Signature Care EPO |
$704.59
|
| Rate for Payer: Signature Care PPO |
$747.03
|
| Rate for Payer: United Healthcare Commercial |
$668.93
|
|
|
HC Z DRILL 2.7 SLEEVE
|
Facility
IP
|
$813.05
|
|
| Hospital Charge Code |
41605862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$609.79 |
| Max. Negotiated Rate |
$756.14 |
| Rate for Payer: Aetna Commercial |
$702.48
|
| Rate for Payer: Cash Price |
$504.09
|
| Rate for Payer: Cigna All Commercial |
$701.66
|
| Rate for Payer: CORVEL All Commercial |
$756.14
|
| Rate for Payer: Coventry All Commercial |
$715.48
|
| Rate for Payer: Encore All Commercial |
$748.41
|
| Rate for Payer: Frontpath All Commercial |
$748.01
|
| Rate for Payer: Humana ChoiceCare |
$702.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$731.74
|
| Rate for Payer: PHCS All Commercial |
$609.79
|
| Rate for Payer: PHP All Commercial |
$616.62
|
| Rate for Payer: Sagamore Health Network All Products |
$627.67
|
| Rate for Payer: Signature Care EPO |
$674.83
|
| Rate for Payer: Signature Care PPO |
$715.48
|
| Rate for Payer: United Healthcare Commercial |
$640.68
|
|
|
HC Z DRILL 2.7 SLEEVE
|
Facility
OP
|
$813.05
|
|
| Hospital Charge Code |
41605862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$756.14 |
| Rate for Payer: Aetna Commercial |
$686.21
|
| Rate for Payer: Aetna Medicare |
$268.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$268.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$466.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$508.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$308.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$295.14
|
| Rate for Payer: Cash Price |
$504.09
|
| Rate for Payer: Cash Price |
$504.09
|
| Rate for Payer: Centivo All Commercial |
$414.66
|
| Rate for Payer: Cigna All Commercial |
$701.66
|
| Rate for Payer: CORVEL All Commercial |
$756.14
|
| Rate for Payer: Coventry All Commercial |
$715.48
|
| Rate for Payer: Encore All Commercial |
$748.41
|
| Rate for Payer: Frontpath All Commercial |
$748.01
|
| Rate for Payer: Humana ChoiceCare |
$702.23
|
| Rate for Payer: Humana Medicare |
$414.66
|
| Rate for Payer: Lucent All Commercial |
$414.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$731.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$609.79
|
| Rate for Payer: PHP All Commercial |
$616.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$317.09
|
| Rate for Payer: Sagamore Health Network All Products |
$627.67
|
| Rate for Payer: Signature Care EPO |
$674.83
|
| Rate for Payer: Signature Care PPO |
$715.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$691.09
|
| Rate for Payer: United Healthcare Commercial |
$640.68
|
| Rate for Payer: United Healthcare Medicare |
$268.31
|
|
|
HC Z DRILL 3.0 AO
|
Facility
OP
|
$678.93
|
|
| Hospital Charge Code |
41606953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$631.40 |
| Rate for Payer: Aetna Commercial |
$573.02
|
| Rate for Payer: Aetna Medicare |
$224.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$224.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$389.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$424.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$257.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$246.45
|
| Rate for Payer: Cash Price |
$420.94
|
| Rate for Payer: Cash Price |
$420.94
|
| Rate for Payer: Centivo All Commercial |
$346.25
|
| Rate for Payer: Cigna All Commercial |
$585.92
|
| Rate for Payer: CORVEL All Commercial |
$631.40
|
| Rate for Payer: Coventry All Commercial |
$597.46
|
| Rate for Payer: Encore All Commercial |
$624.96
|
| Rate for Payer: Frontpath All Commercial |
$624.62
|
| Rate for Payer: Humana ChoiceCare |
$586.39
|
| Rate for Payer: Humana Medicare |
$346.25
|
| Rate for Payer: Lucent All Commercial |
$346.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$611.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$509.20
|
| Rate for Payer: PHP All Commercial |
$514.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$264.78
|
| Rate for Payer: Sagamore Health Network All Products |
$524.13
|
| Rate for Payer: Signature Care EPO |
$563.51
|
| Rate for Payer: Signature Care PPO |
$597.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$577.09
|
| Rate for Payer: United Healthcare Commercial |
$535.00
|
| Rate for Payer: United Healthcare Medicare |
$224.05
|
|
|
HC Z DRILL 3.0 AO
|
Facility
IP
|
$678.93
|
|
| Hospital Charge Code |
41606953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.20 |
| Max. Negotiated Rate |
$631.40 |
| Rate for Payer: Aetna Commercial |
$586.60
|
| Rate for Payer: Cash Price |
$420.94
|
| Rate for Payer: Cigna All Commercial |
$585.92
|
| Rate for Payer: CORVEL All Commercial |
$631.40
|
| Rate for Payer: Coventry All Commercial |
$597.46
|
| Rate for Payer: Encore All Commercial |
$624.96
|
| Rate for Payer: Frontpath All Commercial |
$624.62
|
| Rate for Payer: Humana ChoiceCare |
$586.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$611.04
|
| Rate for Payer: PHCS All Commercial |
$509.20
|
| Rate for Payer: PHP All Commercial |
$514.90
|
| Rate for Payer: Sagamore Health Network All Products |
$524.13
|
| Rate for Payer: Signature Care EPO |
$563.51
|
| Rate for Payer: Signature Care PPO |
$597.46
|
| Rate for Payer: United Healthcare Commercial |
$535.00
|
|
|
HC Z DRILL 3.2 PERC
|
Facility
IP
|
$885.50
|
|
| Hospital Charge Code |
41606948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$664.12 |
| Max. Negotiated Rate |
$823.52 |
| Rate for Payer: Aetna Commercial |
$765.07
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Cigna All Commercial |
$764.19
|
| Rate for Payer: CORVEL All Commercial |
$823.52
|
| Rate for Payer: Coventry All Commercial |
$779.24
|
| Rate for Payer: Encore All Commercial |
$815.10
|
| Rate for Payer: Frontpath All Commercial |
$814.66
|
| Rate for Payer: Humana ChoiceCare |
$764.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.95
|
| Rate for Payer: PHCS All Commercial |
$664.12
|
| Rate for Payer: PHP All Commercial |
$671.56
|
| Rate for Payer: Sagamore Health Network All Products |
$683.61
|
| Rate for Payer: Signature Care EPO |
$734.96
|
| Rate for Payer: Signature Care PPO |
$779.24
|
| Rate for Payer: United Healthcare Commercial |
$697.77
|
|
|
HC Z DRILL 3.2 PERC
|
Facility
OP
|
$885.50
|
|
| Hospital Charge Code |
41606948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$823.52 |
| Rate for Payer: Aetna Commercial |
$747.36
|
| Rate for Payer: Aetna Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$508.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$553.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.44
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Centivo All Commercial |
$451.60
|
| Rate for Payer: Cigna All Commercial |
$764.19
|
| Rate for Payer: CORVEL All Commercial |
$823.52
|
| Rate for Payer: Coventry All Commercial |
$779.24
|
| Rate for Payer: Encore All Commercial |
$815.10
|
| Rate for Payer: Frontpath All Commercial |
$814.66
|
| Rate for Payer: Humana ChoiceCare |
$764.81
|
| Rate for Payer: Humana Medicare |
$451.60
|
| Rate for Payer: Lucent All Commercial |
$451.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$664.12
|
| Rate for Payer: PHP All Commercial |
$671.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.34
|
| Rate for Payer: Sagamore Health Network All Products |
$683.61
|
| Rate for Payer: Signature Care EPO |
$734.96
|
| Rate for Payer: Signature Care PPO |
$779.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.68
|
| Rate for Payer: United Healthcare Commercial |
$697.77
|
| Rate for Payer: United Healthcare Medicare |
$292.22
|
|
|
HC Z DRILL 3.3 AFFIX HUM
|
Facility
OP
|
$1,916.50
|
|
| Hospital Charge Code |
41607420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,782.34 |
| Rate for Payer: Aetna Commercial |
$1,617.53
|
| Rate for Payer: Aetna Medicare |
$632.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,100.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,198.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$727.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$695.69
|
| Rate for Payer: Cash Price |
$1,188.23
|
| Rate for Payer: Cash Price |
$1,188.23
|
| Rate for Payer: Centivo All Commercial |
$977.42
|
| Rate for Payer: Cigna All Commercial |
$1,653.94
|
| Rate for Payer: CORVEL All Commercial |
$1,782.34
|
| Rate for Payer: Coventry All Commercial |
$1,686.52
|
| Rate for Payer: Encore All Commercial |
$1,764.14
|
| Rate for Payer: Frontpath All Commercial |
$1,763.18
|
| Rate for Payer: Humana ChoiceCare |
$1,655.28
|
| Rate for Payer: Humana Medicare |
$977.42
|
| Rate for Payer: Lucent All Commercial |
$977.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,724.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,437.38
|
| Rate for Payer: PHP All Commercial |
$1,453.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$747.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,479.54
|
| Rate for Payer: Signature Care EPO |
$1,590.70
|
| Rate for Payer: Signature Care PPO |
$1,686.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,629.02
|
| Rate for Payer: United Healthcare Commercial |
$1,510.20
|
| Rate for Payer: United Healthcare Medicare |
$632.44
|
|
|
HC Z DRILL 3.3 AFFIX HUM
|
Facility
IP
|
$1,916.50
|
|
| Hospital Charge Code |
41607420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,437.38 |
| Max. Negotiated Rate |
$1,782.34 |
| Rate for Payer: Aetna Commercial |
$1,655.86
|
| Rate for Payer: Cash Price |
$1,188.23
|
| Rate for Payer: Cigna All Commercial |
$1,653.94
|
| Rate for Payer: CORVEL All Commercial |
$1,782.34
|
| Rate for Payer: Coventry All Commercial |
$1,686.52
|
| Rate for Payer: Encore All Commercial |
$1,764.14
|
| Rate for Payer: Frontpath All Commercial |
$1,763.18
|
| Rate for Payer: Humana ChoiceCare |
$1,655.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,724.85
|
| Rate for Payer: PHCS All Commercial |
$1,437.38
|
| Rate for Payer: PHP All Commercial |
$1,453.47
|
| Rate for Payer: Sagamore Health Network All Products |
$1,479.54
|
| Rate for Payer: Signature Care EPO |
$1,590.70
|
| Rate for Payer: Signature Care PPO |
$1,686.52
|
| Rate for Payer: United Healthcare Commercial |
$1,510.20
|
|
|
HC Z DRILL 3.3 FREE HAND
|
Facility
OP
|
$629.23
|
|
| Hospital Charge Code |
41607479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$585.18 |
| Rate for Payer: Aetna Commercial |
$531.07
|
| Rate for Payer: Aetna Medicare |
$207.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$207.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$361.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$238.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$228.41
|
| Rate for Payer: Cash Price |
$390.12
|
| Rate for Payer: Cash Price |
$390.12
|
| Rate for Payer: Centivo All Commercial |
$320.91
|
| Rate for Payer: Cigna All Commercial |
$543.03
|
| Rate for Payer: CORVEL All Commercial |
$585.18
|
| Rate for Payer: Coventry All Commercial |
$553.72
|
| Rate for Payer: Encore All Commercial |
$579.21
|
| Rate for Payer: Frontpath All Commercial |
$578.89
|
| Rate for Payer: Humana ChoiceCare |
$543.47
|
| Rate for Payer: Humana Medicare |
$320.91
|
| Rate for Payer: Lucent All Commercial |
$320.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$471.92
|
| Rate for Payer: PHP All Commercial |
$477.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.40
|
| Rate for Payer: Sagamore Health Network All Products |
$485.77
|
| Rate for Payer: Signature Care EPO |
$522.26
|
| Rate for Payer: Signature Care PPO |
$553.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$534.85
|
| Rate for Payer: United Healthcare Commercial |
$495.83
|
| Rate for Payer: United Healthcare Medicare |
$207.65
|
|
|
HC Z DRILL 3.3 FREE HAND
|
Facility
IP
|
$629.23
|
|
| Hospital Charge Code |
41607479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.92 |
| Max. Negotiated Rate |
$585.18 |
| Rate for Payer: Aetna Commercial |
$543.65
|
| Rate for Payer: Cash Price |
$390.12
|
| Rate for Payer: Cigna All Commercial |
$543.03
|
| Rate for Payer: CORVEL All Commercial |
$585.18
|
| Rate for Payer: Coventry All Commercial |
$553.72
|
| Rate for Payer: Encore All Commercial |
$579.21
|
| Rate for Payer: Frontpath All Commercial |
$578.89
|
| Rate for Payer: Humana ChoiceCare |
$543.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$566.31
|
| Rate for Payer: PHCS All Commercial |
$471.92
|
| Rate for Payer: PHP All Commercial |
$477.21
|
| Rate for Payer: Sagamore Health Network All Products |
$485.77
|
| Rate for Payer: Signature Care EPO |
$522.26
|
| Rate for Payer: Signature Care PPO |
$553.72
|
| Rate for Payer: United Healthcare Commercial |
$495.83
|
|
|
HC Z DRILL 3.5 CANN AO
|
Facility
OP
|
$1,048.30
|
|
| Hospital Charge Code |
41607478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$974.92 |
| Rate for Payer: Aetna Commercial |
$884.77
|
| Rate for Payer: Aetna Medicare |
$345.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$345.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$602.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$655.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$397.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$380.53
|
| Rate for Payer: Cash Price |
$649.95
|
| Rate for Payer: Cash Price |
$649.95
|
| Rate for Payer: Centivo All Commercial |
$534.63
|
| Rate for Payer: Cigna All Commercial |
$904.68
|
| Rate for Payer: CORVEL All Commercial |
$974.92
|
| Rate for Payer: Coventry All Commercial |
$922.50
|
| Rate for Payer: Encore All Commercial |
$964.96
|
| Rate for Payer: Frontpath All Commercial |
$964.44
|
| Rate for Payer: Humana ChoiceCare |
$905.42
|
| Rate for Payer: Humana Medicare |
$534.63
|
| Rate for Payer: Lucent All Commercial |
$534.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$943.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$786.22
|
| Rate for Payer: PHP All Commercial |
$795.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$408.84
|
| Rate for Payer: Sagamore Health Network All Products |
$809.29
|
| Rate for Payer: Signature Care EPO |
$870.09
|
| Rate for Payer: Signature Care PPO |
$922.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$891.06
|
| Rate for Payer: United Healthcare Commercial |
$826.06
|
| Rate for Payer: United Healthcare Medicare |
$345.94
|
|
|
HC Z DRILL 3.5 CANN AO
|
Facility
IP
|
$1,048.30
|
|
| Hospital Charge Code |
41607478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$786.22 |
| Max. Negotiated Rate |
$974.92 |
| Rate for Payer: Aetna Commercial |
$905.73
|
| Rate for Payer: Cash Price |
$649.95
|
| Rate for Payer: Cigna All Commercial |
$904.68
|
| Rate for Payer: CORVEL All Commercial |
$974.92
|
| Rate for Payer: Coventry All Commercial |
$922.50
|
| Rate for Payer: Encore All Commercial |
$964.96
|
| Rate for Payer: Frontpath All Commercial |
$964.44
|
| Rate for Payer: Humana ChoiceCare |
$905.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$943.47
|
| Rate for Payer: PHCS All Commercial |
$786.22
|
| Rate for Payer: PHP All Commercial |
$795.03
|
| Rate for Payer: Sagamore Health Network All Products |
$809.29
|
| Rate for Payer: Signature Care EPO |
$870.09
|
| Rate for Payer: Signature Care PPO |
$922.50
|
| Rate for Payer: United Healthcare Commercial |
$826.06
|
|
|
HC Z DRILL 3.7 STD
|
Facility
IP
|
$862.26
|
|
| Hospital Charge Code |
41606189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.70 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Aetna Commercial |
$744.99
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna All Commercial |
$744.13
|
| Rate for Payer: CORVEL All Commercial |
$801.90
|
| Rate for Payer: Coventry All Commercial |
$758.79
|
| Rate for Payer: Encore All Commercial |
$793.71
|
| Rate for Payer: Frontpath All Commercial |
$793.28
|
| Rate for Payer: Humana ChoiceCare |
$744.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$776.03
|
| Rate for Payer: PHCS All Commercial |
$646.70
|
| Rate for Payer: PHP All Commercial |
$653.94
|
| Rate for Payer: Sagamore Health Network All Products |
$665.66
|
| Rate for Payer: Signature Care EPO |
$715.68
|
| Rate for Payer: Signature Care PPO |
$758.79
|
| Rate for Payer: United Healthcare Commercial |
$679.46
|
|
|
HC Z DRILL 3.7 STD
|
Facility
OP
|
$862.26
|
|
| Hospital Charge Code |
41606189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Aetna Commercial |
$727.75
|
| Rate for Payer: Aetna Medicare |
$284.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$284.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$495.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$539.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$327.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$313.00
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Centivo All Commercial |
$439.75
|
| Rate for Payer: Cigna All Commercial |
$744.13
|
| Rate for Payer: CORVEL All Commercial |
$801.90
|
| Rate for Payer: Coventry All Commercial |
$758.79
|
| Rate for Payer: Encore All Commercial |
$793.71
|
| Rate for Payer: Frontpath All Commercial |
$793.28
|
| Rate for Payer: Humana ChoiceCare |
$744.73
|
| Rate for Payer: Humana Medicare |
$439.75
|
| Rate for Payer: Lucent All Commercial |
$439.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$776.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$646.70
|
| Rate for Payer: PHP All Commercial |
$653.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$336.28
|
| Rate for Payer: Sagamore Health Network All Products |
$665.66
|
| Rate for Payer: Signature Care EPO |
$715.68
|
| Rate for Payer: Signature Care PPO |
$758.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$732.92
|
| Rate for Payer: United Healthcare Commercial |
$679.46
|
| Rate for Payer: United Healthcare Medicare |
$284.55
|
|
|
HC Z DRILL 4.0 MD
|
Facility
OP
|
$885.50
|
|
| Hospital Charge Code |
41607495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$823.52 |
| Rate for Payer: Aetna Commercial |
$747.36
|
| Rate for Payer: Aetna Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$508.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$553.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.44
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Cash Price |
$549.01
|
| Rate for Payer: Centivo All Commercial |
$451.60
|
| Rate for Payer: Cigna All Commercial |
$764.19
|
| Rate for Payer: CORVEL All Commercial |
$823.52
|
| Rate for Payer: Coventry All Commercial |
$779.24
|
| Rate for Payer: Encore All Commercial |
$815.10
|
| Rate for Payer: Frontpath All Commercial |
$814.66
|
| Rate for Payer: Humana ChoiceCare |
$764.81
|
| Rate for Payer: Humana Medicare |
$451.60
|
| Rate for Payer: Lucent All Commercial |
$451.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$664.12
|
| Rate for Payer: PHP All Commercial |
$671.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.34
|
| Rate for Payer: Sagamore Health Network All Products |
$683.61
|
| Rate for Payer: Signature Care EPO |
$734.96
|
| Rate for Payer: Signature Care PPO |
$779.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.68
|
| Rate for Payer: United Healthcare Commercial |
$697.77
|
| Rate for Payer: United Healthcare Medicare |
$292.22
|
|
