|
HC Z GRAFT SEMIT ONLY FZ
|
Facility
IP
|
$5,040.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,780.00 |
| Max. Negotiated Rate |
$4,687.20 |
| Rate for Payer: Aetna Commercial |
$4,354.56
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cigna All Commercial |
$4,349.52
|
| Rate for Payer: CORVEL All Commercial |
$4,687.20
|
| Rate for Payer: Coventry All Commercial |
$4,435.20
|
| Rate for Payer: Encore All Commercial |
$4,639.32
|
| Rate for Payer: Frontpath All Commercial |
$4,636.80
|
| Rate for Payer: Humana ChoiceCare |
$4,353.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,536.00
|
| Rate for Payer: PHCS All Commercial |
$3,780.00
|
| Rate for Payer: PHP All Commercial |
$3,822.34
|
| Rate for Payer: Sagamore Health Network All Products |
$3,890.88
|
| Rate for Payer: Signature Care EPO |
$4,183.20
|
| Rate for Payer: Signature Care PPO |
$4,435.20
|
| Rate for Payer: United Healthcare Commercial |
$3,971.52
|
|
|
HC Z GRAFT SEMIT ONLY FZ
|
Facility
OP
|
$5,040.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41606519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,687.20 |
| Rate for Payer: Aetna Commercial |
$4,253.76
|
| Rate for Payer: Aetna Medicare |
$1,663.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,663.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,894.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,150.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,912.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,829.52
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Centivo All Commercial |
$2,570.40
|
| Rate for Payer: Cigna All Commercial |
$4,349.52
|
| Rate for Payer: CORVEL All Commercial |
$4,687.20
|
| Rate for Payer: Coventry All Commercial |
$4,435.20
|
| Rate for Payer: Encore All Commercial |
$4,639.32
|
| Rate for Payer: Frontpath All Commercial |
$4,636.80
|
| Rate for Payer: Humana ChoiceCare |
$4,353.05
|
| Rate for Payer: Humana Medicare |
$2,570.40
|
| Rate for Payer: Lucent All Commercial |
$2,570.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,536.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,780.00
|
| Rate for Payer: PHP All Commercial |
$3,822.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,965.60
|
| Rate for Payer: Sagamore Health Network All Products |
$3,890.88
|
| Rate for Payer: Signature Care EPO |
$4,183.20
|
| Rate for Payer: Signature Care PPO |
$4,435.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,284.00
|
| Rate for Payer: United Healthcare Commercial |
$3,971.52
|
| Rate for Payer: United Healthcare Medicare |
$1,663.20
|
|
|
HC Z GUIDE 2.2 SOFT TISSUE
|
Facility
IP
|
$807.50
|
|
| Hospital Charge Code |
41606492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.62 |
| Max. Negotiated Rate |
$750.98 |
| Rate for Payer: Aetna Commercial |
$697.68
|
| Rate for Payer: Cash Price |
$500.65
|
| Rate for Payer: Cigna All Commercial |
$696.87
|
| Rate for Payer: CORVEL All Commercial |
$750.98
|
| Rate for Payer: Coventry All Commercial |
$710.60
|
| Rate for Payer: Encore All Commercial |
$743.30
|
| Rate for Payer: Frontpath All Commercial |
$742.90
|
| Rate for Payer: Humana ChoiceCare |
$697.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$726.75
|
| Rate for Payer: PHCS All Commercial |
$605.62
|
| Rate for Payer: PHP All Commercial |
$612.41
|
| Rate for Payer: Sagamore Health Network All Products |
$623.39
|
| Rate for Payer: Signature Care EPO |
$670.22
|
| Rate for Payer: Signature Care PPO |
$710.60
|
| Rate for Payer: United Healthcare Commercial |
$636.31
|
|
|
HC Z GUIDE 2.2 SOFT TISSUE
|
Facility
OP
|
$807.50
|
|
| Hospital Charge Code |
41606492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$750.98 |
| Rate for Payer: Aetna Commercial |
$681.53
|
| Rate for Payer: Aetna Medicare |
$266.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$266.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$463.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$504.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$306.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$293.12
|
| Rate for Payer: Cash Price |
$500.65
|
| Rate for Payer: Cash Price |
$500.65
|
| Rate for Payer: Centivo All Commercial |
$411.82
|
| Rate for Payer: Cigna All Commercial |
$696.87
|
| Rate for Payer: CORVEL All Commercial |
$750.98
|
| Rate for Payer: Coventry All Commercial |
$710.60
|
| Rate for Payer: Encore All Commercial |
$743.30
|
| Rate for Payer: Frontpath All Commercial |
$742.90
|
| Rate for Payer: Humana ChoiceCare |
$697.44
|
| Rate for Payer: Humana Medicare |
$411.82
|
| Rate for Payer: Lucent All Commercial |
$411.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$726.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$605.62
|
| Rate for Payer: PHP All Commercial |
$612.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$314.92
|
| Rate for Payer: Sagamore Health Network All Products |
$623.39
|
| Rate for Payer: Signature Care EPO |
$670.22
|
| Rate for Payer: Signature Care PPO |
$710.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$686.38
|
| Rate for Payer: United Healthcare Commercial |
$636.31
|
| Rate for Payer: United Healthcare Medicare |
$266.48
|
|
|
HC Z GUIDE 2.7 SOFT TISSUE
|
Facility
IP
|
$807.50
|
|
| Hospital Charge Code |
41606493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.62 |
| Max. Negotiated Rate |
$750.98 |
| Rate for Payer: Aetna Commercial |
$697.68
|
| Rate for Payer: Cash Price |
$500.65
|
| Rate for Payer: Cigna All Commercial |
$696.87
|
| Rate for Payer: CORVEL All Commercial |
$750.98
|
| Rate for Payer: Coventry All Commercial |
$710.60
|
| Rate for Payer: Encore All Commercial |
$743.30
|
| Rate for Payer: Frontpath All Commercial |
$742.90
|
| Rate for Payer: Humana ChoiceCare |
$697.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$726.75
|
| Rate for Payer: PHCS All Commercial |
$605.62
|
| Rate for Payer: PHP All Commercial |
$612.41
|
| Rate for Payer: Sagamore Health Network All Products |
$623.39
|
| Rate for Payer: Signature Care EPO |
$670.22
|
| Rate for Payer: Signature Care PPO |
$710.60
|
| Rate for Payer: United Healthcare Commercial |
$636.31
|
|
|
HC Z GUIDE 2.7 SOFT TISSUE
|
Facility
OP
|
$807.50
|
|
| Hospital Charge Code |
41606493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$750.98 |
| Rate for Payer: Aetna Commercial |
$681.53
|
| Rate for Payer: Aetna Medicare |
$266.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$266.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$463.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$504.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$306.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$293.12
|
| Rate for Payer: Cash Price |
$500.65
|
| Rate for Payer: Cash Price |
$500.65
|
| Rate for Payer: Centivo All Commercial |
$411.82
|
| Rate for Payer: Cigna All Commercial |
$696.87
|
| Rate for Payer: CORVEL All Commercial |
$750.98
|
| Rate for Payer: Coventry All Commercial |
$710.60
|
| Rate for Payer: Encore All Commercial |
$743.30
|
| Rate for Payer: Frontpath All Commercial |
$742.90
|
| Rate for Payer: Humana ChoiceCare |
$697.44
|
| Rate for Payer: Humana Medicare |
$411.82
|
| Rate for Payer: Lucent All Commercial |
$411.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$726.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$605.62
|
| Rate for Payer: PHP All Commercial |
$612.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$314.92
|
| Rate for Payer: Sagamore Health Network All Products |
$623.39
|
| Rate for Payer: Signature Care EPO |
$670.22
|
| Rate for Payer: Signature Care PPO |
$710.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$686.38
|
| Rate for Payer: United Healthcare Commercial |
$636.31
|
| Rate for Payer: United Healthcare Medicare |
$266.48
|
|
|
HC Z GUIDE PIN 1.6X6 PT
|
Facility
OP
|
$582.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.24 |
| Max. Negotiated Rate |
$541.76 |
| Rate for Payer: Aetna Commercial |
$491.66
|
| Rate for Payer: Aetna Medicare |
$192.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$334.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$364.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.46
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Centivo All Commercial |
$297.10
|
| Rate for Payer: Cigna All Commercial |
$502.73
|
| Rate for Payer: CORVEL All Commercial |
$541.76
|
| Rate for Payer: Coventry All Commercial |
$512.64
|
| Rate for Payer: Encore All Commercial |
$536.23
|
| Rate for Payer: Frontpath All Commercial |
$535.94
|
| Rate for Payer: Humana ChoiceCare |
$503.14
|
| Rate for Payer: Humana Medicare |
$297.10
|
| Rate for Payer: Lucent All Commercial |
$297.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$524.29
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$436.90
|
| Rate for Payer: PHP All Commercial |
$441.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.19
|
| Rate for Payer: Sagamore Health Network All Products |
$449.72
|
| Rate for Payer: Signature Care EPO |
$483.51
|
| Rate for Payer: Signature Care PPO |
$512.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$495.16
|
| Rate for Payer: United Healthcare Commercial |
$459.04
|
| Rate for Payer: United Healthcare Medicare |
$192.24
|
|
|
HC Z GUIDE PIN 1.6X6 PT
|
Facility
IP
|
$582.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$436.90 |
| Max. Negotiated Rate |
$541.76 |
| Rate for Payer: Aetna Commercial |
$503.31
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Cigna All Commercial |
$502.73
|
| Rate for Payer: CORVEL All Commercial |
$541.76
|
| Rate for Payer: Coventry All Commercial |
$512.64
|
| Rate for Payer: Encore All Commercial |
$536.23
|
| Rate for Payer: Frontpath All Commercial |
$535.94
|
| Rate for Payer: Humana ChoiceCare |
$503.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$524.29
|
| Rate for Payer: PHCS All Commercial |
$436.90
|
| Rate for Payer: PHP All Commercial |
$441.80
|
| Rate for Payer: Sagamore Health Network All Products |
$449.72
|
| Rate for Payer: Signature Care EPO |
$483.51
|
| Rate for Payer: Signature Care PPO |
$512.64
|
| Rate for Payer: United Healthcare Commercial |
$459.04
|
|
|
HC Z GUIDE PIN 1.6X6 TROC TIP
|
Facility
OP
|
$382.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$322.58
|
| Rate for Payer: Aetna Medicare |
$126.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$219.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.74
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Centivo All Commercial |
$194.92
|
| Rate for Payer: Cigna All Commercial |
$329.84
|
| Rate for Payer: CORVEL All Commercial |
$355.45
|
| Rate for Payer: Coventry All Commercial |
$336.34
|
| Rate for Payer: Encore All Commercial |
$351.82
|
| Rate for Payer: Frontpath All Commercial |
$351.62
|
| Rate for Payer: Humana ChoiceCare |
$330.11
|
| Rate for Payer: Humana Medicare |
$194.92
|
| Rate for Payer: Lucent All Commercial |
$194.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$286.65
|
| Rate for Payer: PHP All Commercial |
$289.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.06
|
| Rate for Payer: Sagamore Health Network All Products |
$295.06
|
| Rate for Payer: Signature Care EPO |
$317.23
|
| Rate for Payer: Signature Care PPO |
$336.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$324.87
|
| Rate for Payer: United Healthcare Commercial |
$301.17
|
| Rate for Payer: United Healthcare Medicare |
$126.13
|
|
|
HC Z GUIDE PIN 1.6X6 TROC TIP
|
Facility
IP
|
$382.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$355.45 |
| Rate for Payer: Aetna Commercial |
$330.22
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cigna All Commercial |
$329.84
|
| Rate for Payer: CORVEL All Commercial |
$355.45
|
| Rate for Payer: Coventry All Commercial |
$336.34
|
| Rate for Payer: Encore All Commercial |
$351.82
|
| Rate for Payer: Frontpath All Commercial |
$351.62
|
| Rate for Payer: Humana ChoiceCare |
$330.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.98
|
| Rate for Payer: PHCS All Commercial |
$286.65
|
| Rate for Payer: PHP All Commercial |
$289.86
|
| Rate for Payer: Sagamore Health Network All Products |
$295.06
|
| Rate for Payer: Signature Care EPO |
$317.23
|
| Rate for Payer: Signature Care PPO |
$336.34
|
| Rate for Payer: United Healthcare Commercial |
$301.17
|
|
|
HC Z GUIDE PIN 1.6X9 TROC TIP
|
Facility
OP
|
$382.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$322.58
|
| Rate for Payer: Aetna Medicare |
$126.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$219.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.74
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Centivo All Commercial |
$194.92
|
| Rate for Payer: Cigna All Commercial |
$329.84
|
| Rate for Payer: CORVEL All Commercial |
$355.45
|
| Rate for Payer: Coventry All Commercial |
$336.34
|
| Rate for Payer: Encore All Commercial |
$351.82
|
| Rate for Payer: Frontpath All Commercial |
$351.62
|
| Rate for Payer: Humana ChoiceCare |
$330.11
|
| Rate for Payer: Humana Medicare |
$194.92
|
| Rate for Payer: Lucent All Commercial |
$194.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.98
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$286.65
|
| Rate for Payer: PHP All Commercial |
$289.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.06
|
| Rate for Payer: Sagamore Health Network All Products |
$295.06
|
| Rate for Payer: Signature Care EPO |
$317.23
|
| Rate for Payer: Signature Care PPO |
$336.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$324.87
|
| Rate for Payer: United Healthcare Commercial |
$301.17
|
| Rate for Payer: United Healthcare Medicare |
$126.13
|
|
|
HC Z GUIDE PIN 1.6X9 TROC TIP
|
Facility
IP
|
$382.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$355.45 |
| Rate for Payer: Aetna Commercial |
$330.22
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cigna All Commercial |
$329.84
|
| Rate for Payer: CORVEL All Commercial |
$355.45
|
| Rate for Payer: Coventry All Commercial |
$336.34
|
| Rate for Payer: Encore All Commercial |
$351.82
|
| Rate for Payer: Frontpath All Commercial |
$351.62
|
| Rate for Payer: Humana ChoiceCare |
$330.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.98
|
| Rate for Payer: PHCS All Commercial |
$286.65
|
| Rate for Payer: PHP All Commercial |
$289.86
|
| Rate for Payer: Sagamore Health Network All Products |
$295.06
|
| Rate for Payer: Signature Care EPO |
$317.23
|
| Rate for Payer: Signature Care PPO |
$336.34
|
| Rate for Payer: United Healthcare Commercial |
$301.17
|
|
|
HC Z GUIDE PIN 1.6X9 TROC TIP PT
|
Facility
IP
|
$582.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$436.90 |
| Max. Negotiated Rate |
$541.76 |
| Rate for Payer: Aetna Commercial |
$503.31
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Cigna All Commercial |
$502.73
|
| Rate for Payer: CORVEL All Commercial |
$541.76
|
| Rate for Payer: Coventry All Commercial |
$512.64
|
| Rate for Payer: Encore All Commercial |
$536.23
|
| Rate for Payer: Frontpath All Commercial |
$535.94
|
| Rate for Payer: Humana ChoiceCare |
$503.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$524.29
|
| Rate for Payer: PHCS All Commercial |
$436.90
|
| Rate for Payer: PHP All Commercial |
$441.80
|
| Rate for Payer: Sagamore Health Network All Products |
$449.72
|
| Rate for Payer: Signature Care EPO |
$483.51
|
| Rate for Payer: Signature Care PPO |
$512.64
|
| Rate for Payer: United Healthcare Commercial |
$459.04
|
|
|
HC Z GUIDE PIN 1.6X9 TROC TIP PT
|
Facility
OP
|
$582.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.24 |
| Max. Negotiated Rate |
$541.76 |
| Rate for Payer: Aetna Commercial |
$491.66
|
| Rate for Payer: Aetna Medicare |
$192.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$334.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$364.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.46
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Centivo All Commercial |
$297.10
|
| Rate for Payer: Cigna All Commercial |
$502.73
|
| Rate for Payer: CORVEL All Commercial |
$541.76
|
| Rate for Payer: Coventry All Commercial |
$512.64
|
| Rate for Payer: Encore All Commercial |
$536.23
|
| Rate for Payer: Frontpath All Commercial |
$535.94
|
| Rate for Payer: Humana ChoiceCare |
$503.14
|
| Rate for Payer: Humana Medicare |
$297.10
|
| Rate for Payer: Lucent All Commercial |
$297.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$524.29
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$436.90
|
| Rate for Payer: PHP All Commercial |
$441.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.19
|
| Rate for Payer: Sagamore Health Network All Products |
$449.72
|
| Rate for Payer: Signature Care EPO |
$483.51
|
| Rate for Payer: Signature Care PPO |
$512.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$495.16
|
| Rate for Payer: United Healthcare Commercial |
$459.04
|
| Rate for Payer: United Healthcare Medicare |
$192.24
|
|
|
HC Z GUIDE PIN 2.5
|
Facility
OP
|
$176.75
|
|
| Hospital Charge Code |
41607421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.33 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Aetna Commercial |
$149.18
|
| Rate for Payer: Aetna Medicare |
$58.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$101.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.16
|
| Rate for Payer: Cash Price |
$109.59
|
| Rate for Payer: Cash Price |
$109.59
|
| Rate for Payer: Centivo All Commercial |
$90.14
|
| Rate for Payer: Cigna All Commercial |
$152.54
|
| Rate for Payer: CORVEL All Commercial |
$164.38
|
| Rate for Payer: Coventry All Commercial |
$155.54
|
| Rate for Payer: Encore All Commercial |
$162.70
|
| Rate for Payer: Frontpath All Commercial |
$162.61
|
| Rate for Payer: Humana ChoiceCare |
$152.66
|
| Rate for Payer: Humana Medicare |
$90.14
|
| Rate for Payer: Lucent All Commercial |
$90.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$132.56
|
| Rate for Payer: PHP All Commercial |
$134.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.93
|
| Rate for Payer: Sagamore Health Network All Products |
$136.45
|
| Rate for Payer: Signature Care EPO |
$146.70
|
| Rate for Payer: Signature Care PPO |
$155.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$150.24
|
| Rate for Payer: United Healthcare Commercial |
$139.28
|
| Rate for Payer: United Healthcare Medicare |
$58.33
|
|
|
HC Z GUIDE PIN 2.5
|
Facility
IP
|
$176.75
|
|
| Hospital Charge Code |
41607421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.56 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Aetna Commercial |
$152.71
|
| Rate for Payer: Cash Price |
$109.59
|
| Rate for Payer: Cigna All Commercial |
$152.54
|
| Rate for Payer: CORVEL All Commercial |
$164.38
|
| Rate for Payer: Coventry All Commercial |
$155.54
|
| Rate for Payer: Encore All Commercial |
$162.70
|
| Rate for Payer: Frontpath All Commercial |
$162.61
|
| Rate for Payer: Humana ChoiceCare |
$152.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.08
|
| Rate for Payer: PHCS All Commercial |
$132.56
|
| Rate for Payer: PHP All Commercial |
$134.05
|
| Rate for Payer: Sagamore Health Network All Products |
$136.45
|
| Rate for Payer: Signature Care EPO |
$146.70
|
| Rate for Payer: Signature Care PPO |
$155.54
|
| Rate for Payer: United Healthcare Commercial |
$139.28
|
|
|
HC Z GUIDE PIN 3.2 STD
|
Facility
IP
|
$865.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.16 |
| Max. Negotiated Rate |
$804.96 |
| Rate for Payer: Aetna Commercial |
$747.84
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Cigna All Commercial |
$746.97
|
| Rate for Payer: CORVEL All Commercial |
$804.96
|
| Rate for Payer: Coventry All Commercial |
$761.68
|
| Rate for Payer: Encore All Commercial |
$796.74
|
| Rate for Payer: Frontpath All Commercial |
$796.31
|
| Rate for Payer: Humana ChoiceCare |
$747.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.00
|
| Rate for Payer: PHCS All Commercial |
$649.16
|
| Rate for Payer: PHP All Commercial |
$656.43
|
| Rate for Payer: Sagamore Health Network All Products |
$668.20
|
| Rate for Payer: Signature Care EPO |
$718.41
|
| Rate for Payer: Signature Care PPO |
$761.68
|
| Rate for Payer: United Healthcare Commercial |
$682.05
|
|
|
HC Z GUIDE PIN 3.2 STD
|
Facility
OP
|
$865.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$804.96 |
| Rate for Payer: Aetna Commercial |
$730.52
|
| Rate for Payer: Aetna Medicare |
$285.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$497.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$541.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.19
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Cash Price |
$536.64
|
| Rate for Payer: Centivo All Commercial |
$441.43
|
| Rate for Payer: Cigna All Commercial |
$746.97
|
| Rate for Payer: CORVEL All Commercial |
$804.96
|
| Rate for Payer: Coventry All Commercial |
$761.68
|
| Rate for Payer: Encore All Commercial |
$796.74
|
| Rate for Payer: Frontpath All Commercial |
$796.31
|
| Rate for Payer: Humana ChoiceCare |
$747.58
|
| Rate for Payer: Humana Medicare |
$441.43
|
| Rate for Payer: Lucent All Commercial |
$441.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$779.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$649.16
|
| Rate for Payer: PHP All Commercial |
$656.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.56
|
| Rate for Payer: Sagamore Health Network All Products |
$668.20
|
| Rate for Payer: Signature Care EPO |
$718.41
|
| Rate for Payer: Signature Care PPO |
$761.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$735.72
|
| Rate for Payer: United Healthcare Commercial |
$682.05
|
| Rate for Payer: United Healthcare Medicare |
$285.63
|
|
|
HC Z GUIDE PIN 3.2X12 DRI
|
Facility
IP
|
$838.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.21 |
| Max. Negotiated Rate |
$780.22 |
| Rate for Payer: Aetna Commercial |
$724.85
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Cigna All Commercial |
$724.01
|
| Rate for Payer: CORVEL All Commercial |
$780.22
|
| Rate for Payer: Coventry All Commercial |
$738.28
|
| Rate for Payer: Encore All Commercial |
$772.25
|
| Rate for Payer: Frontpath All Commercial |
$771.83
|
| Rate for Payer: Humana ChoiceCare |
$724.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$755.06
|
| Rate for Payer: PHCS All Commercial |
$629.21
|
| Rate for Payer: PHP All Commercial |
$636.26
|
| Rate for Payer: Sagamore Health Network All Products |
$647.67
|
| Rate for Payer: Signature Care EPO |
$696.33
|
| Rate for Payer: Signature Care PPO |
$738.28
|
| Rate for Payer: United Healthcare Commercial |
$661.09
|
|
|
HC Z GUIDE PIN 3.2X12 DRI
|
Facility
OP
|
$838.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$780.22 |
| Rate for Payer: Aetna Commercial |
$708.07
|
| Rate for Payer: Aetna Medicare |
$276.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$276.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$481.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$524.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$318.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$304.54
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Centivo All Commercial |
$427.86
|
| Rate for Payer: Cigna All Commercial |
$724.01
|
| Rate for Payer: CORVEL All Commercial |
$780.22
|
| Rate for Payer: Coventry All Commercial |
$738.28
|
| Rate for Payer: Encore All Commercial |
$772.25
|
| Rate for Payer: Frontpath All Commercial |
$771.83
|
| Rate for Payer: Humana ChoiceCare |
$724.60
|
| Rate for Payer: Humana Medicare |
$427.86
|
| Rate for Payer: Lucent All Commercial |
$427.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$755.06
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$629.21
|
| Rate for Payer: PHP All Commercial |
$636.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.19
|
| Rate for Payer: Sagamore Health Network All Products |
$647.67
|
| Rate for Payer: Signature Care EPO |
$696.33
|
| Rate for Payer: Signature Care PPO |
$738.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$713.11
|
| Rate for Payer: United Healthcare Commercial |
$661.09
|
| Rate for Payer: United Healthcare Medicare |
$276.85
|
|
|
HC Z GUIDE PIN 3.2X12 TRO
|
Facility
IP
|
$838.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.21 |
| Max. Negotiated Rate |
$780.22 |
| Rate for Payer: Aetna Commercial |
$724.85
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Cigna All Commercial |
$724.01
|
| Rate for Payer: CORVEL All Commercial |
$780.22
|
| Rate for Payer: Coventry All Commercial |
$738.28
|
| Rate for Payer: Encore All Commercial |
$772.25
|
| Rate for Payer: Frontpath All Commercial |
$771.83
|
| Rate for Payer: Humana ChoiceCare |
$724.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$755.06
|
| Rate for Payer: PHCS All Commercial |
$629.21
|
| Rate for Payer: PHP All Commercial |
$636.26
|
| Rate for Payer: Sagamore Health Network All Products |
$647.67
|
| Rate for Payer: Signature Care EPO |
$696.33
|
| Rate for Payer: Signature Care PPO |
$738.28
|
| Rate for Payer: United Healthcare Commercial |
$661.09
|
|
|
HC Z GUIDE PIN 3.2X12 TRO
|
Facility
OP
|
$838.95
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$780.22 |
| Rate for Payer: Aetna Commercial |
$708.07
|
| Rate for Payer: Aetna Medicare |
$276.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$276.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$481.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$524.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$318.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$304.54
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Cash Price |
$520.15
|
| Rate for Payer: Centivo All Commercial |
$427.86
|
| Rate for Payer: Cigna All Commercial |
$724.01
|
| Rate for Payer: CORVEL All Commercial |
$780.22
|
| Rate for Payer: Coventry All Commercial |
$738.28
|
| Rate for Payer: Encore All Commercial |
$772.25
|
| Rate for Payer: Frontpath All Commercial |
$771.83
|
| Rate for Payer: Humana ChoiceCare |
$724.60
|
| Rate for Payer: Humana Medicare |
$427.86
|
| Rate for Payer: Lucent All Commercial |
$427.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$755.06
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$629.21
|
| Rate for Payer: PHP All Commercial |
$636.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.19
|
| Rate for Payer: Sagamore Health Network All Products |
$647.67
|
| Rate for Payer: Signature Care EPO |
$696.33
|
| Rate for Payer: Signature Care PPO |
$738.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$713.11
|
| Rate for Payer: United Healthcare Commercial |
$661.09
|
| Rate for Payer: United Healthcare Medicare |
$276.85
|
|
|
HC Z GUIDE PIN 3.2X12 TRO
|
Facility
OP
|
$582.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.24 |
| Max. Negotiated Rate |
$541.76 |
| Rate for Payer: Aetna Commercial |
$491.66
|
| Rate for Payer: Aetna Medicare |
$192.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$334.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$364.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.46
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Centivo All Commercial |
$297.10
|
| Rate for Payer: Cigna All Commercial |
$502.73
|
| Rate for Payer: CORVEL All Commercial |
$541.76
|
| Rate for Payer: Coventry All Commercial |
$512.64
|
| Rate for Payer: Encore All Commercial |
$536.23
|
| Rate for Payer: Frontpath All Commercial |
$535.94
|
| Rate for Payer: Humana ChoiceCare |
$503.14
|
| Rate for Payer: Humana Medicare |
$297.10
|
| Rate for Payer: Lucent All Commercial |
$297.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$524.29
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$436.90
|
| Rate for Payer: PHP All Commercial |
$441.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.19
|
| Rate for Payer: Sagamore Health Network All Products |
$449.72
|
| Rate for Payer: Signature Care EPO |
$483.51
|
| Rate for Payer: Signature Care PPO |
$512.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$495.16
|
| Rate for Payer: United Healthcare Commercial |
$459.04
|
| Rate for Payer: United Healthcare Medicare |
$192.24
|
|
|
HC Z GUIDE PIN 3.2X12 TRO
|
Facility
IP
|
$582.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$436.90 |
| Max. Negotiated Rate |
$541.76 |
| Rate for Payer: Aetna Commercial |
$503.31
|
| Rate for Payer: Cash Price |
$361.18
|
| Rate for Payer: Cigna All Commercial |
$502.73
|
| Rate for Payer: CORVEL All Commercial |
$541.76
|
| Rate for Payer: Coventry All Commercial |
$512.64
|
| Rate for Payer: Encore All Commercial |
$536.23
|
| Rate for Payer: Frontpath All Commercial |
$535.94
|
| Rate for Payer: Humana ChoiceCare |
$503.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$524.29
|
| Rate for Payer: PHCS All Commercial |
$436.90
|
| Rate for Payer: PHP All Commercial |
$441.80
|
| Rate for Payer: Sagamore Health Network All Products |
$449.72
|
| Rate for Payer: Signature Care EPO |
$483.51
|
| Rate for Payer: Signature Care PPO |
$512.64
|
| Rate for Payer: United Healthcare Commercial |
$459.04
|
|
|
HC Z GUIDE PIN 3.2X14
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cigna All Commercial |
$671.16
|
| Rate for Payer: CORVEL All Commercial |
$723.26
|
| Rate for Payer: Coventry All Commercial |
$684.38
|
| Rate for Payer: Encore All Commercial |
$715.87
|
| Rate for Payer: Frontpath All Commercial |
$715.48
|
| Rate for Payer: Humana ChoiceCare |
$671.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Sagamore Health Network All Products |
$600.38
|
| Rate for Payer: Signature Care EPO |
$645.49
|
| Rate for Payer: Signature Care PPO |
$684.38
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
|
