|
HC Z GUIDE PIN 3.2X14
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| 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: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| 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: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z GUIDE PIN 3.2X444
|
Facility
OP
|
$968.59
|
|
| Hospital Charge Code |
41606242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$817.49
|
| Rate for Payer: Aetna Medicare |
$319.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$319.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$556.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$605.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.60
|
| Rate for Payer: Cash Price |
$600.53
|
| Rate for Payer: Cash Price |
$600.53
|
| Rate for Payer: Centivo All Commercial |
$493.98
|
| Rate for Payer: Cigna All Commercial |
$835.89
|
| Rate for Payer: CORVEL All Commercial |
$900.79
|
| Rate for Payer: Coventry All Commercial |
$852.36
|
| Rate for Payer: Encore All Commercial |
$891.59
|
| Rate for Payer: Frontpath All Commercial |
$891.10
|
| Rate for Payer: Humana ChoiceCare |
$836.57
|
| Rate for Payer: Humana Medicare |
$493.98
|
| Rate for Payer: Lucent All Commercial |
$493.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$726.44
|
| Rate for Payer: PHP All Commercial |
$734.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$377.75
|
| Rate for Payer: Sagamore Health Network All Products |
$747.75
|
| Rate for Payer: Signature Care EPO |
$803.93
|
| Rate for Payer: Signature Care PPO |
$852.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$823.30
|
| Rate for Payer: United Healthcare Commercial |
$763.25
|
| Rate for Payer: United Healthcare Medicare |
$319.63
|
|
|
HC Z GUIDE PIN 3.2X444
|
Facility
IP
|
$968.59
|
|
| Hospital Charge Code |
41606242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$726.44 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$836.86
|
| Rate for Payer: Cash Price |
$600.53
|
| Rate for Payer: Cigna All Commercial |
$835.89
|
| Rate for Payer: CORVEL All Commercial |
$900.79
|
| Rate for Payer: Coventry All Commercial |
$852.36
|
| Rate for Payer: Encore All Commercial |
$891.59
|
| Rate for Payer: Frontpath All Commercial |
$891.10
|
| Rate for Payer: Humana ChoiceCare |
$836.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.73
|
| Rate for Payer: PHCS All Commercial |
$726.44
|
| Rate for Payer: PHP All Commercial |
$734.58
|
| Rate for Payer: Sagamore Health Network All Products |
$747.75
|
| Rate for Payer: Signature Care EPO |
$803.93
|
| Rate for Payer: Signature Care PPO |
$852.36
|
| Rate for Payer: United Healthcare Commercial |
$763.25
|
|
|
HC Z GUIDE PIN 3.2X9 DRIL
|
Facility
OP
|
$792.33
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.47 |
| Max. Negotiated Rate |
$736.87 |
| Rate for Payer: Aetna Commercial |
$668.73
|
| Rate for Payer: Aetna Medicare |
$261.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$261.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$455.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$495.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$300.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$287.62
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Centivo All Commercial |
$404.09
|
| Rate for Payer: Cigna All Commercial |
$683.78
|
| Rate for Payer: CORVEL All Commercial |
$736.87
|
| Rate for Payer: Coventry All Commercial |
$697.25
|
| Rate for Payer: Encore All Commercial |
$729.34
|
| Rate for Payer: Frontpath All Commercial |
$728.94
|
| Rate for Payer: Humana ChoiceCare |
$684.34
|
| Rate for Payer: Humana Medicare |
$404.09
|
| Rate for Payer: Lucent All Commercial |
$404.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$713.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$594.25
|
| Rate for Payer: PHP All Commercial |
$600.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$309.01
|
| Rate for Payer: Sagamore Health Network All Products |
$611.68
|
| Rate for Payer: Signature Care EPO |
$657.63
|
| Rate for Payer: Signature Care PPO |
$697.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$673.48
|
| Rate for Payer: United Healthcare Commercial |
$624.36
|
| Rate for Payer: United Healthcare Medicare |
$261.47
|
|
|
HC Z GUIDE PIN 3.2X9 DRIL
|
Facility
IP
|
$792.33
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.25 |
| Max. Negotiated Rate |
$736.87 |
| Rate for Payer: Aetna Commercial |
$684.57
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cigna All Commercial |
$683.78
|
| Rate for Payer: CORVEL All Commercial |
$736.87
|
| Rate for Payer: Coventry All Commercial |
$697.25
|
| Rate for Payer: Encore All Commercial |
$729.34
|
| Rate for Payer: Frontpath All Commercial |
$728.94
|
| Rate for Payer: Humana ChoiceCare |
$684.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$713.10
|
| Rate for Payer: PHCS All Commercial |
$594.25
|
| Rate for Payer: PHP All Commercial |
$600.90
|
| Rate for Payer: Sagamore Health Network All Products |
$611.68
|
| Rate for Payer: Signature Care EPO |
$657.63
|
| Rate for Payer: Signature Care PPO |
$697.25
|
| Rate for Payer: United Healthcare Commercial |
$624.36
|
|
|
HC Z GUIDE PIN 3.2X9 TROC
|
Facility
IP
|
$792.33
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.25 |
| Max. Negotiated Rate |
$736.87 |
| Rate for Payer: Aetna Commercial |
$684.57
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cigna All Commercial |
$683.78
|
| Rate for Payer: CORVEL All Commercial |
$736.87
|
| Rate for Payer: Coventry All Commercial |
$697.25
|
| Rate for Payer: Encore All Commercial |
$729.34
|
| Rate for Payer: Frontpath All Commercial |
$728.94
|
| Rate for Payer: Humana ChoiceCare |
$684.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$713.10
|
| Rate for Payer: PHCS All Commercial |
$594.25
|
| Rate for Payer: PHP All Commercial |
$600.90
|
| Rate for Payer: Sagamore Health Network All Products |
$611.68
|
| Rate for Payer: Signature Care EPO |
$657.63
|
| Rate for Payer: Signature Care PPO |
$697.25
|
| Rate for Payer: United Healthcare Commercial |
$624.36
|
|
|
HC Z GUIDE PIN 3.2X9 TROC
|
Facility
OP
|
$792.33
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.47 |
| Max. Negotiated Rate |
$736.87 |
| Rate for Payer: Aetna Commercial |
$668.73
|
| Rate for Payer: Aetna Medicare |
$261.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$261.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$455.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$495.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$300.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$287.62
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Centivo All Commercial |
$404.09
|
| Rate for Payer: Cigna All Commercial |
$683.78
|
| Rate for Payer: CORVEL All Commercial |
$736.87
|
| Rate for Payer: Coventry All Commercial |
$697.25
|
| Rate for Payer: Encore All Commercial |
$729.34
|
| Rate for Payer: Frontpath All Commercial |
$728.94
|
| Rate for Payer: Humana ChoiceCare |
$684.34
|
| Rate for Payer: Humana Medicare |
$404.09
|
| Rate for Payer: Lucent All Commercial |
$404.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$713.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$594.25
|
| Rate for Payer: PHP All Commercial |
$600.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$309.01
|
| Rate for Payer: Sagamore Health Network All Products |
$611.68
|
| Rate for Payer: Signature Care EPO |
$657.63
|
| Rate for Payer: Signature Care PPO |
$697.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$673.48
|
| Rate for Payer: United Healthcare Commercial |
$624.36
|
| Rate for Payer: United Healthcare Medicare |
$261.47
|
|
|
HC Z GUIDE PIN 3.2X9 TROC
|
Facility
OP
|
$582.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604078
|
|
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 3.2X9 TROC
|
Facility
IP
|
$582.54
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604078
|
|
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 GUIDEWIRE 2.0 BALL NOSE
|
Facility
IP
|
$1,111.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$833.25 |
| Max. Negotiated Rate |
$1,033.23 |
| Rate for Payer: Aetna Commercial |
$959.90
|
| Rate for Payer: Cash Price |
$688.82
|
| Rate for Payer: Cigna All Commercial |
$958.79
|
| Rate for Payer: CORVEL All Commercial |
$1,033.23
|
| Rate for Payer: Coventry All Commercial |
$977.68
|
| Rate for Payer: Encore All Commercial |
$1,022.68
|
| Rate for Payer: Frontpath All Commercial |
$1,022.12
|
| Rate for Payer: Humana ChoiceCare |
$959.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$999.90
|
| Rate for Payer: PHCS All Commercial |
$833.25
|
| Rate for Payer: PHP All Commercial |
$842.58
|
| Rate for Payer: Sagamore Health Network All Products |
$857.69
|
| Rate for Payer: Signature Care EPO |
$922.13
|
| Rate for Payer: Signature Care PPO |
$977.68
|
| Rate for Payer: United Healthcare Commercial |
$875.47
|
|
|
HC Z GUIDEWIRE 2.0 BALL NOSE
|
Facility
OP
|
$1,111.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.63 |
| Max. Negotiated Rate |
$1,033.23 |
| Rate for Payer: Aetna Commercial |
$937.68
|
| Rate for Payer: Aetna Medicare |
$366.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$366.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$638.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$694.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$421.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$403.29
|
| Rate for Payer: Cash Price |
$688.82
|
| Rate for Payer: Cash Price |
$688.82
|
| Rate for Payer: Centivo All Commercial |
$566.61
|
| Rate for Payer: Cigna All Commercial |
$958.79
|
| Rate for Payer: CORVEL All Commercial |
$1,033.23
|
| Rate for Payer: Coventry All Commercial |
$977.68
|
| Rate for Payer: Encore All Commercial |
$1,022.68
|
| Rate for Payer: Frontpath All Commercial |
$1,022.12
|
| Rate for Payer: Humana ChoiceCare |
$959.57
|
| Rate for Payer: Humana Medicare |
$566.61
|
| Rate for Payer: Lucent All Commercial |
$566.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$999.90
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$833.25
|
| Rate for Payer: PHP All Commercial |
$842.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$433.29
|
| Rate for Payer: Sagamore Health Network All Products |
$857.69
|
| Rate for Payer: Signature Care EPO |
$922.13
|
| Rate for Payer: Signature Care PPO |
$977.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$944.35
|
| Rate for Payer: United Healthcare Commercial |
$875.47
|
| Rate for Payer: United Healthcare Medicare |
$366.63
|
|
|
HC Z GUIDEWIRE 2.2X28
|
Facility
IP
|
$968.59
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.44 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$836.86
|
| Rate for Payer: Cash Price |
$600.53
|
| Rate for Payer: Cigna All Commercial |
$835.89
|
| Rate for Payer: CORVEL All Commercial |
$900.79
|
| Rate for Payer: Coventry All Commercial |
$852.36
|
| Rate for Payer: Encore All Commercial |
$891.59
|
| Rate for Payer: Frontpath All Commercial |
$891.10
|
| Rate for Payer: Humana ChoiceCare |
$836.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.73
|
| Rate for Payer: PHCS All Commercial |
$726.44
|
| Rate for Payer: PHP All Commercial |
$734.58
|
| Rate for Payer: Sagamore Health Network All Products |
$747.75
|
| Rate for Payer: Signature Care EPO |
$803.93
|
| Rate for Payer: Signature Care PPO |
$852.36
|
| Rate for Payer: United Healthcare Commercial |
$763.25
|
|
|
HC Z GUIDEWIRE 2.2X28
|
Facility
OP
|
$968.59
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.63 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$817.49
|
| Rate for Payer: Aetna Medicare |
$319.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$319.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$556.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$605.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.60
|
| Rate for Payer: Cash Price |
$600.53
|
| Rate for Payer: Cash Price |
$600.53
|
| Rate for Payer: Centivo All Commercial |
$493.98
|
| Rate for Payer: Cigna All Commercial |
$835.89
|
| Rate for Payer: CORVEL All Commercial |
$900.79
|
| Rate for Payer: Coventry All Commercial |
$852.36
|
| Rate for Payer: Encore All Commercial |
$891.59
|
| Rate for Payer: Frontpath All Commercial |
$891.10
|
| Rate for Payer: Humana ChoiceCare |
$836.57
|
| Rate for Payer: Humana Medicare |
$493.98
|
| Rate for Payer: Lucent All Commercial |
$493.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.73
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$726.44
|
| Rate for Payer: PHP All Commercial |
$734.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$377.75
|
| Rate for Payer: Sagamore Health Network All Products |
$747.75
|
| Rate for Payer: Signature Care EPO |
$803.93
|
| Rate for Payer: Signature Care PPO |
$852.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$823.30
|
| Rate for Payer: United Healthcare Commercial |
$763.25
|
| Rate for Payer: United Healthcare Medicare |
$319.63
|
|
|
HC Z GUIDEWIRE 2.4X70
|
Facility
OP
|
$792.33
|
|
| Hospital Charge Code |
41606655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$736.87 |
| Rate for Payer: Aetna Commercial |
$668.73
|
| Rate for Payer: Aetna Medicare |
$261.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$261.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$455.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$495.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$300.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$287.62
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Centivo All Commercial |
$404.09
|
| Rate for Payer: Cigna All Commercial |
$683.78
|
| Rate for Payer: CORVEL All Commercial |
$736.87
|
| Rate for Payer: Coventry All Commercial |
$697.25
|
| Rate for Payer: Encore All Commercial |
$729.34
|
| Rate for Payer: Frontpath All Commercial |
$728.94
|
| Rate for Payer: Humana ChoiceCare |
$684.34
|
| Rate for Payer: Humana Medicare |
$404.09
|
| Rate for Payer: Lucent All Commercial |
$404.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$713.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$594.25
|
| Rate for Payer: PHP All Commercial |
$600.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$309.01
|
| Rate for Payer: Sagamore Health Network All Products |
$611.68
|
| Rate for Payer: Signature Care EPO |
$657.63
|
| Rate for Payer: Signature Care PPO |
$697.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$673.48
|
| Rate for Payer: United Healthcare Commercial |
$624.36
|
| Rate for Payer: United Healthcare Medicare |
$261.47
|
|
|
HC Z GUIDEWIRE 2.4X70
|
Facility
IP
|
$792.33
|
|
| Hospital Charge Code |
41606655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$594.25 |
| Max. Negotiated Rate |
$736.87 |
| Rate for Payer: Aetna Commercial |
$684.57
|
| Rate for Payer: Cash Price |
$491.25
|
| Rate for Payer: Cigna All Commercial |
$683.78
|
| Rate for Payer: CORVEL All Commercial |
$736.87
|
| Rate for Payer: Coventry All Commercial |
$697.25
|
| Rate for Payer: Encore All Commercial |
$729.34
|
| Rate for Payer: Frontpath All Commercial |
$728.94
|
| Rate for Payer: Humana ChoiceCare |
$684.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$713.10
|
| Rate for Payer: PHCS All Commercial |
$594.25
|
| Rate for Payer: PHP All Commercial |
$600.90
|
| Rate for Payer: Sagamore Health Network All Products |
$611.68
|
| Rate for Payer: Signature Care EPO |
$657.63
|
| Rate for Payer: Signature Care PPO |
$697.25
|
| Rate for Payer: United Healthcare Commercial |
$624.36
|
|
|
HC Z GUIDE WIRE 3.2
|
Facility
IP
|
$865.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606944
|
|
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 WIRE 3.2
|
Facility
OP
|
$865.55
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606944
|
|
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 GUIDEWIRE AFFIX HUM
|
Facility
IP
|
$1,610.95
|
|
| Hospital Charge Code |
41607423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,208.21 |
| Max. Negotiated Rate |
$1,498.18 |
| Rate for Payer: Aetna Commercial |
$1,391.86
|
| Rate for Payer: Cash Price |
$998.79
|
| Rate for Payer: Cigna All Commercial |
$1,390.25
|
| Rate for Payer: CORVEL All Commercial |
$1,498.18
|
| Rate for Payer: Coventry All Commercial |
$1,417.64
|
| Rate for Payer: Encore All Commercial |
$1,482.88
|
| Rate for Payer: Frontpath All Commercial |
$1,482.07
|
| Rate for Payer: Humana ChoiceCare |
$1,391.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.86
|
| Rate for Payer: PHCS All Commercial |
$1,208.21
|
| Rate for Payer: PHP All Commercial |
$1,221.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,243.65
|
| Rate for Payer: Signature Care EPO |
$1,337.09
|
| Rate for Payer: Signature Care PPO |
$1,417.64
|
| Rate for Payer: United Healthcare Commercial |
$1,269.43
|
|
|
HC Z GUIDEWIRE AFFIX HUM
|
Facility
OP
|
$1,610.95
|
|
| Hospital Charge Code |
41607423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,498.18 |
| Rate for Payer: Aetna Commercial |
$1,359.64
|
| Rate for Payer: Aetna Medicare |
$531.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$531.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$925.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,007.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$611.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$584.77
|
| Rate for Payer: Cash Price |
$998.79
|
| Rate for Payer: Cash Price |
$998.79
|
| Rate for Payer: Centivo All Commercial |
$821.58
|
| Rate for Payer: Cigna All Commercial |
$1,390.25
|
| Rate for Payer: CORVEL All Commercial |
$1,498.18
|
| Rate for Payer: Coventry All Commercial |
$1,417.64
|
| Rate for Payer: Encore All Commercial |
$1,482.88
|
| Rate for Payer: Frontpath All Commercial |
$1,482.07
|
| Rate for Payer: Humana ChoiceCare |
$1,391.38
|
| Rate for Payer: Humana Medicare |
$821.58
|
| Rate for Payer: Lucent All Commercial |
$821.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.86
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,208.21
|
| Rate for Payer: PHP All Commercial |
$1,221.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$628.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,243.65
|
| Rate for Payer: Signature Care EPO |
$1,337.09
|
| Rate for Payer: Signature Care PPO |
$1,417.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,369.31
|
| Rate for Payer: United Healthcare Commercial |
$1,269.43
|
| Rate for Payer: United Healthcare Medicare |
$531.61
|
|
|
HC Z GUIDEWIRE BALL NOSE 3.0X100
|
Facility
OP
|
$933.24
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.97 |
| Max. Negotiated Rate |
$867.91 |
| Rate for Payer: Aetna Commercial |
$787.65
|
| Rate for Payer: Aetna Medicare |
$307.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$535.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$583.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.77
|
| Rate for Payer: Cash Price |
$578.61
|
| Rate for Payer: Cash Price |
$578.61
|
| Rate for Payer: Centivo All Commercial |
$475.95
|
| Rate for Payer: Cigna All Commercial |
$805.39
|
| Rate for Payer: CORVEL All Commercial |
$867.91
|
| Rate for Payer: Coventry All Commercial |
$821.25
|
| Rate for Payer: Encore All Commercial |
$859.05
|
| Rate for Payer: Frontpath All Commercial |
$858.58
|
| Rate for Payer: Humana ChoiceCare |
$806.04
|
| Rate for Payer: Humana Medicare |
$475.95
|
| Rate for Payer: Lucent All Commercial |
$475.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$839.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$699.93
|
| Rate for Payer: PHP All Commercial |
$707.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.96
|
| Rate for Payer: Sagamore Health Network All Products |
$720.46
|
| Rate for Payer: Signature Care EPO |
$774.59
|
| Rate for Payer: Signature Care PPO |
$821.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$793.25
|
| Rate for Payer: United Healthcare Commercial |
$735.39
|
| Rate for Payer: United Healthcare Medicare |
$307.97
|
|
|
HC Z GUIDEWIRE BALL NOSE 3.0X100
|
Facility
IP
|
$933.24
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.93 |
| Max. Negotiated Rate |
$867.91 |
| Rate for Payer: Aetna Commercial |
$806.32
|
| Rate for Payer: Cash Price |
$578.61
|
| Rate for Payer: Cigna All Commercial |
$805.39
|
| Rate for Payer: CORVEL All Commercial |
$867.91
|
| Rate for Payer: Coventry All Commercial |
$821.25
|
| Rate for Payer: Encore All Commercial |
$859.05
|
| Rate for Payer: Frontpath All Commercial |
$858.58
|
| Rate for Payer: Humana ChoiceCare |
$806.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$839.92
|
| Rate for Payer: PHCS All Commercial |
$699.93
|
| Rate for Payer: PHP All Commercial |
$707.77
|
| Rate for Payer: Sagamore Health Network All Products |
$720.46
|
| Rate for Payer: Signature Care EPO |
$774.59
|
| Rate for Payer: Signature Care PPO |
$821.25
|
| Rate for Payer: United Healthcare Commercial |
$735.39
|
|
|
HC Z GUIDEWIRE BEAD TIP 3X98
|
Facility
OP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$723.26 |
| Rate for Payer: Aetna Commercial |
$656.38
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$256.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$446.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.31
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Cash Price |
$482.17
|
| Rate for Payer: Centivo All Commercial |
$396.63
|
| 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: Humana Medicare |
$396.63
|
| Rate for Payer: Lucent All Commercial |
$396.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$699.93
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$583.28
|
| Rate for Payer: PHP All Commercial |
$589.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.30
|
| 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: Three Rivers Preferred All Commercial |
$661.04
|
| Rate for Payer: United Healthcare Commercial |
$612.83
|
| Rate for Payer: United Healthcare Medicare |
$256.64
|
|
|
HC Z GUIDEWIRE BEAD TIP 3X98
|
Facility
IP
|
$777.70
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603905
|
|
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
|
|
|
HC Z GUIDEWIRE TEAR DROP 3X100
|
Facility
IP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$675.95
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
|
|
HC Z GUIDEWIRE TEAR DROP 3X100
|
Facility
OP
|
$782.35
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.18 |
| Max. Negotiated Rate |
$727.59 |
| Rate for Payer: Aetna Commercial |
$660.30
|
| Rate for Payer: Aetna Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$296.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$283.99
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Cash Price |
$485.06
|
| Rate for Payer: Centivo All Commercial |
$399.00
|
| Rate for Payer: Cigna All Commercial |
$675.17
|
| Rate for Payer: CORVEL All Commercial |
$727.59
|
| Rate for Payer: Coventry All Commercial |
$688.47
|
| Rate for Payer: Encore All Commercial |
$720.15
|
| Rate for Payer: Frontpath All Commercial |
$719.76
|
| Rate for Payer: Humana ChoiceCare |
$675.72
|
| Rate for Payer: Humana Medicare |
$399.00
|
| Rate for Payer: Lucent All Commercial |
$399.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$704.12
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$586.76
|
| Rate for Payer: PHP All Commercial |
$593.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.12
|
| Rate for Payer: Sagamore Health Network All Products |
$603.97
|
| Rate for Payer: Signature Care EPO |
$649.35
|
| Rate for Payer: Signature Care PPO |
$688.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$665.00
|
| Rate for Payer: United Healthcare Commercial |
$616.49
|
| Rate for Payer: United Healthcare Medicare |
$258.18
|
|
