|
HC Z N-FORCE K-WIRE 1.4
|
Facility
OP
|
$392.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$330.85
|
| Rate for Payer: Aetna Medicare |
$129.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$225.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$245.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$142.30
|
| Rate for Payer: Cash Price |
$243.04
|
| Rate for Payer: Cash Price |
$243.04
|
| Rate for Payer: Centivo All Commercial |
$199.92
|
| Rate for Payer: Cigna All Commercial |
$338.30
|
| Rate for Payer: CORVEL All Commercial |
$364.56
|
| Rate for Payer: Coventry All Commercial |
$344.96
|
| Rate for Payer: Encore All Commercial |
$360.84
|
| Rate for Payer: Frontpath All Commercial |
$360.64
|
| Rate for Payer: Humana ChoiceCare |
$338.57
|
| Rate for Payer: Humana Medicare |
$199.92
|
| Rate for Payer: Lucent All Commercial |
$199.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$352.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$294.00
|
| Rate for Payer: PHP All Commercial |
$297.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.88
|
| Rate for Payer: Sagamore Health Network All Products |
$302.62
|
| Rate for Payer: Signature Care EPO |
$325.36
|
| Rate for Payer: Signature Care PPO |
$344.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$333.20
|
| Rate for Payer: United Healthcare Commercial |
$308.90
|
| Rate for Payer: United Healthcare Medicare |
$129.36
|
|
|
HC Z N-FORCE K-WIRE 1.4
|
Facility
IP
|
$392.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$364.56 |
| Rate for Payer: Aetna Commercial |
$338.69
|
| Rate for Payer: Cash Price |
$243.04
|
| Rate for Payer: Cigna All Commercial |
$338.30
|
| Rate for Payer: CORVEL All Commercial |
$364.56
|
| Rate for Payer: Coventry All Commercial |
$344.96
|
| Rate for Payer: Encore All Commercial |
$360.84
|
| Rate for Payer: Frontpath All Commercial |
$360.64
|
| Rate for Payer: Humana ChoiceCare |
$338.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$352.80
|
| Rate for Payer: PHCS All Commercial |
$294.00
|
| Rate for Payer: PHP All Commercial |
$297.29
|
| Rate for Payer: Sagamore Health Network All Products |
$302.62
|
| Rate for Payer: Signature Care EPO |
$325.36
|
| Rate for Payer: Signature Care PPO |
$344.96
|
| Rate for Payer: United Healthcare Commercial |
$308.90
|
|
|
HC Z N-FORCE K-WIRE 3.2
|
Facility
OP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,055.00
|
| Rate for Payer: Aetna Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$717.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$781.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$474.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$453.75
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Centivo All Commercial |
$637.50
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Humana Medicare |
$637.50
|
| Rate for Payer: Lucent All Commercial |
$637.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$487.50
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.50
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
| Rate for Payer: United Healthcare Medicare |
$412.50
|
|
|
HC Z N-FORCE K-WIRE 3.2
|
Facility
IP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
|
|
HC Z N-FORCE MIXING SYSTEM
|
Facility
IP
|
$1,100.00
|
|
| Hospital Charge Code |
41606089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna Commercial |
$950.40
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna All Commercial |
$949.30
|
| Rate for Payer: CORVEL All Commercial |
$1,023.00
|
| Rate for Payer: Coventry All Commercial |
$968.00
|
| Rate for Payer: Encore All Commercial |
$1,012.55
|
| Rate for Payer: Frontpath All Commercial |
$1,012.00
|
| Rate for Payer: Humana ChoiceCare |
$950.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$990.00
|
| Rate for Payer: PHCS All Commercial |
$825.00
|
| Rate for Payer: PHP All Commercial |
$834.24
|
| Rate for Payer: Sagamore Health Network All Products |
$849.20
|
| Rate for Payer: Signature Care EPO |
$913.00
|
| Rate for Payer: Signature Care PPO |
$968.00
|
| Rate for Payer: United Healthcare Commercial |
$866.80
|
|
|
HC Z N-FORCE MIXING SYSTEM
|
Facility
OP
|
$1,100.00
|
|
| Hospital Charge Code |
41606089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna Commercial |
$928.40
|
| Rate for Payer: Aetna Medicare |
$363.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$363.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$631.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.30
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Centivo All Commercial |
$561.00
|
| Rate for Payer: Cigna All Commercial |
$949.30
|
| Rate for Payer: CORVEL All Commercial |
$1,023.00
|
| Rate for Payer: Coventry All Commercial |
$968.00
|
| Rate for Payer: Encore All Commercial |
$1,012.55
|
| Rate for Payer: Frontpath All Commercial |
$1,012.00
|
| Rate for Payer: Humana ChoiceCare |
$950.07
|
| Rate for Payer: Humana Medicare |
$561.00
|
| Rate for Payer: Lucent All Commercial |
$561.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$990.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$825.00
|
| Rate for Payer: PHP All Commercial |
$834.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$429.00
|
| Rate for Payer: Sagamore Health Network All Products |
$849.20
|
| Rate for Payer: Signature Care EPO |
$913.00
|
| Rate for Payer: Signature Care PPO |
$968.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$935.00
|
| Rate for Payer: United Healthcare Commercial |
$866.80
|
| Rate for Payer: United Healthcare Medicare |
$363.00
|
|
|
HC Z N-FORCE SCREW 4.0X30
|
Facility
IP
|
$1,837.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.12 |
| Max. Negotiated Rate |
$1,708.88 |
| Rate for Payer: Aetna Commercial |
$1,587.60
|
| Rate for Payer: Cash Price |
$1,139.25
|
| Rate for Payer: Cigna All Commercial |
$1,585.76
|
| Rate for Payer: CORVEL All Commercial |
$1,708.88
|
| Rate for Payer: Coventry All Commercial |
$1,617.00
|
| Rate for Payer: Encore All Commercial |
$1,691.42
|
| Rate for Payer: Frontpath All Commercial |
$1,690.50
|
| Rate for Payer: Humana ChoiceCare |
$1,587.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,653.75
|
| Rate for Payer: PHCS All Commercial |
$1,378.12
|
| Rate for Payer: PHP All Commercial |
$1,393.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,418.55
|
| Rate for Payer: Signature Care EPO |
$1,525.12
|
| Rate for Payer: Signature Care PPO |
$1,617.00
|
| Rate for Payer: United Healthcare Commercial |
$1,447.95
|
|
|
HC Z N-FORCE SCREW 4.0X30
|
Facility
OP
|
$1,837.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,708.88 |
| Rate for Payer: Aetna Commercial |
$1,550.85
|
| Rate for Payer: Aetna Medicare |
$606.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$606.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,055.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,148.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$697.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$667.01
|
| Rate for Payer: Cash Price |
$1,139.25
|
| Rate for Payer: Cash Price |
$1,139.25
|
| Rate for Payer: Centivo All Commercial |
$937.12
|
| Rate for Payer: Cigna All Commercial |
$1,585.76
|
| Rate for Payer: CORVEL All Commercial |
$1,708.88
|
| Rate for Payer: Coventry All Commercial |
$1,617.00
|
| Rate for Payer: Encore All Commercial |
$1,691.42
|
| Rate for Payer: Frontpath All Commercial |
$1,690.50
|
| Rate for Payer: Humana ChoiceCare |
$1,587.05
|
| Rate for Payer: Humana Medicare |
$937.12
|
| Rate for Payer: Lucent All Commercial |
$937.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,653.75
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,378.12
|
| Rate for Payer: PHP All Commercial |
$1,393.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$716.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,418.55
|
| Rate for Payer: Signature Care EPO |
$1,525.12
|
| Rate for Payer: Signature Care PPO |
$1,617.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,561.88
|
| Rate for Payer: United Healthcare Commercial |
$1,447.95
|
| Rate for Payer: United Healthcare Medicare |
$606.38
|
|
|
HC Z N-FORCE SCREW 4.0X45
|
Facility
OP
|
$2,484.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,096.50
|
| Rate for Payer: Aetna Medicare |
$819.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$819.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,426.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,552.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$942.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$901.69
|
| Rate for Payer: Cash Price |
$1,540.08
|
| Rate for Payer: Cash Price |
$1,540.08
|
| Rate for Payer: Centivo All Commercial |
$1,266.84
|
| Rate for Payer: Cigna All Commercial |
$2,143.69
|
| Rate for Payer: CORVEL All Commercial |
$2,310.12
|
| Rate for Payer: Coventry All Commercial |
$2,185.92
|
| Rate for Payer: Encore All Commercial |
$2,286.52
|
| Rate for Payer: Frontpath All Commercial |
$2,285.28
|
| Rate for Payer: Humana ChoiceCare |
$2,145.43
|
| Rate for Payer: Humana Medicare |
$1,266.84
|
| Rate for Payer: Lucent All Commercial |
$1,266.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,235.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,863.00
|
| Rate for Payer: PHP All Commercial |
$1,883.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$968.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,917.65
|
| Rate for Payer: Signature Care EPO |
$2,061.72
|
| Rate for Payer: Signature Care PPO |
$2,185.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,111.40
|
| Rate for Payer: United Healthcare Commercial |
$1,957.39
|
| Rate for Payer: United Healthcare Medicare |
$819.72
|
|
|
HC Z N-FORCE SCREW 4.0X45
|
Facility
IP
|
$2,484.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,863.00 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,146.18
|
| Rate for Payer: Cash Price |
$1,540.08
|
| Rate for Payer: Cigna All Commercial |
$2,143.69
|
| Rate for Payer: CORVEL All Commercial |
$2,310.12
|
| Rate for Payer: Coventry All Commercial |
$2,185.92
|
| Rate for Payer: Encore All Commercial |
$2,286.52
|
| Rate for Payer: Frontpath All Commercial |
$2,285.28
|
| Rate for Payer: Humana ChoiceCare |
$2,145.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,235.60
|
| Rate for Payer: PHCS All Commercial |
$1,863.00
|
| Rate for Payer: PHP All Commercial |
$1,883.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,917.65
|
| Rate for Payer: Signature Care EPO |
$2,061.72
|
| Rate for Payer: Signature Care PPO |
$2,185.92
|
| Rate for Payer: United Healthcare Commercial |
$1,957.39
|
|
|
HC ZONISAMIDE
|
Facility
OP
|
$389.90
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
63001381
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$362.60 |
| Rate for Payer: Aetna Commercial |
$329.07
|
| Rate for Payer: Aetna Medicare |
$128.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$223.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$243.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.53
|
| Rate for Payer: Cash Price |
$241.74
|
| Rate for Payer: Cash Price |
$241.74
|
| Rate for Payer: Centivo All Commercial |
$198.85
|
| Rate for Payer: Cigna All Commercial |
$336.48
|
| Rate for Payer: CORVEL All Commercial |
$362.60
|
| Rate for Payer: Coventry All Commercial |
$343.11
|
| Rate for Payer: Encore All Commercial |
$358.90
|
| Rate for Payer: Frontpath All Commercial |
$358.70
|
| Rate for Payer: Humana ChoiceCare |
$336.75
|
| Rate for Payer: Humana Medicare |
$198.85
|
| Rate for Payer: Lucent All Commercial |
$198.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$350.91
|
| Rate for Payer: Managed Health Services Medicaid |
$13.25
|
| Rate for Payer: MDWise Medicaid |
$13.25
|
| Rate for Payer: PHCS All Commercial |
$292.42
|
| Rate for Payer: PHP All Commercial |
$295.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.06
|
| Rate for Payer: Sagamore Health Network All Products |
$301.00
|
| Rate for Payer: Signature Care EPO |
$323.61
|
| Rate for Payer: Signature Care PPO |
$343.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$331.41
|
| Rate for Payer: United Healthcare Commercial |
$307.24
|
| Rate for Payer: United Healthcare Medicare |
$128.67
|
|
|
HC ZONISAMIDE
|
Facility
IP
|
$389.90
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
63001381
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$292.42 |
| Max. Negotiated Rate |
$362.60 |
| Rate for Payer: Aetna Commercial |
$336.87
|
| Rate for Payer: Cash Price |
$241.74
|
| Rate for Payer: Cigna All Commercial |
$336.48
|
| Rate for Payer: CORVEL All Commercial |
$362.60
|
| Rate for Payer: Coventry All Commercial |
$343.11
|
| Rate for Payer: Encore All Commercial |
$358.90
|
| Rate for Payer: Frontpath All Commercial |
$358.70
|
| Rate for Payer: Humana ChoiceCare |
$336.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$350.91
|
| Rate for Payer: PHCS All Commercial |
$292.42
|
| Rate for Payer: PHP All Commercial |
$295.70
|
| Rate for Payer: Sagamore Health Network All Products |
$301.00
|
| Rate for Payer: Signature Care EPO |
$323.61
|
| Rate for Payer: Signature Care PPO |
$343.11
|
| Rate for Payer: United Healthcare Commercial |
$307.24
|
|
|
HC Z OXF PART FEM CMT MD
|
Facility
OP
|
$10,651.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,905.79 |
| Rate for Payer: Aetna Commercial |
$8,989.77
|
| Rate for Payer: Aetna Medicare |
$3,514.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,514.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,117.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,658.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,042.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,866.45
|
| Rate for Payer: Cash Price |
$6,603.86
|
| Rate for Payer: Cash Price |
$6,603.86
|
| Rate for Payer: Centivo All Commercial |
$5,432.21
|
| Rate for Payer: Cigna All Commercial |
$9,192.15
|
| Rate for Payer: CORVEL All Commercial |
$9,905.79
|
| Rate for Payer: Coventry All Commercial |
$9,373.22
|
| Rate for Payer: Encore All Commercial |
$9,804.60
|
| Rate for Payer: Frontpath All Commercial |
$9,799.28
|
| Rate for Payer: Humana ChoiceCare |
$9,199.61
|
| Rate for Payer: Humana Medicare |
$5,432.21
|
| Rate for Payer: Lucent All Commercial |
$5,432.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,586.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,988.54
|
| Rate for Payer: PHP All Commercial |
$8,078.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,154.04
|
| Rate for Payer: Sagamore Health Network All Products |
$8,222.87
|
| Rate for Payer: Signature Care EPO |
$8,840.65
|
| Rate for Payer: Signature Care PPO |
$9,373.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,053.68
|
| Rate for Payer: United Healthcare Commercial |
$8,393.30
|
| Rate for Payer: United Healthcare Medicare |
$3,514.96
|
|
|
HC Z OXF PART FEM CMT MD
|
Facility
IP
|
$10,651.39
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,988.54 |
| Max. Negotiated Rate |
$9,905.79 |
| Rate for Payer: Aetna Commercial |
$9,202.80
|
| Rate for Payer: Cash Price |
$6,603.86
|
| Rate for Payer: Cigna All Commercial |
$9,192.15
|
| Rate for Payer: CORVEL All Commercial |
$9,905.79
|
| Rate for Payer: Coventry All Commercial |
$9,373.22
|
| Rate for Payer: Encore All Commercial |
$9,804.60
|
| Rate for Payer: Frontpath All Commercial |
$9,799.28
|
| Rate for Payer: Humana ChoiceCare |
$9,199.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,586.25
|
| Rate for Payer: PHCS All Commercial |
$7,988.54
|
| Rate for Payer: PHP All Commercial |
$8,078.01
|
| Rate for Payer: Sagamore Health Network All Products |
$8,222.87
|
| Rate for Payer: Signature Care EPO |
$8,840.65
|
| Rate for Payer: Signature Care PPO |
$9,373.22
|
| Rate for Payer: United Healthcare Commercial |
$8,393.30
|
|
|
HC Z OXF PART LAT TIB C4 R
|
Facility
OP
|
$6,458.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,006.31 |
| Rate for Payer: Aetna Commercial |
$5,450.89
|
| Rate for Payer: Aetna Medicare |
$2,131.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,131.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,709.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,037.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,450.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,344.40
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Centivo All Commercial |
$3,293.78
|
| Rate for Payer: Cigna All Commercial |
$5,573.60
|
| Rate for Payer: CORVEL All Commercial |
$6,006.31
|
| Rate for Payer: Coventry All Commercial |
$5,683.39
|
| Rate for Payer: Encore All Commercial |
$5,944.96
|
| Rate for Payer: Frontpath All Commercial |
$5,941.73
|
| Rate for Payer: Humana ChoiceCare |
$5,578.12
|
| Rate for Payer: Humana Medicare |
$3,293.78
|
| Rate for Payer: Lucent All Commercial |
$3,293.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,812.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,843.80
|
| Rate for Payer: PHP All Commercial |
$4,898.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,518.78
|
| Rate for Payer: Sagamore Health Network All Products |
$4,985.88
|
| Rate for Payer: Signature Care EPO |
$5,360.47
|
| Rate for Payer: Signature Care PPO |
$5,683.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,489.64
|
| Rate for Payer: United Healthcare Commercial |
$5,089.22
|
| Rate for Payer: United Healthcare Medicare |
$2,131.27
|
|
|
HC Z OXF PART LAT TIB C4 R
|
Facility
IP
|
$6,458.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,843.80 |
| Max. Negotiated Rate |
$6,006.31 |
| Rate for Payer: Aetna Commercial |
$5,580.06
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Cigna All Commercial |
$5,573.60
|
| Rate for Payer: CORVEL All Commercial |
$6,006.31
|
| Rate for Payer: Coventry All Commercial |
$5,683.39
|
| Rate for Payer: Encore All Commercial |
$5,944.96
|
| Rate for Payer: Frontpath All Commercial |
$5,941.73
|
| Rate for Payer: Humana ChoiceCare |
$5,578.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,812.56
|
| Rate for Payer: PHCS All Commercial |
$4,843.80
|
| Rate for Payer: PHP All Commercial |
$4,898.05
|
| Rate for Payer: Sagamore Health Network All Products |
$4,985.88
|
| Rate for Payer: Signature Care EPO |
$5,360.47
|
| Rate for Payer: Signature Care PPO |
$5,683.39
|
| Rate for Payer: United Healthcare Commercial |
$5,089.22
|
|
|
HC Z OXF PART LAT TIB E6 R
|
Facility
OP
|
$6,458.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,006.31 |
| Rate for Payer: Aetna Commercial |
$5,450.89
|
| Rate for Payer: Aetna Medicare |
$2,131.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,131.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,709.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,037.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,450.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,344.40
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Centivo All Commercial |
$3,293.78
|
| Rate for Payer: Cigna All Commercial |
$5,573.60
|
| Rate for Payer: CORVEL All Commercial |
$6,006.31
|
| Rate for Payer: Coventry All Commercial |
$5,683.39
|
| Rate for Payer: Encore All Commercial |
$5,944.96
|
| Rate for Payer: Frontpath All Commercial |
$5,941.73
|
| Rate for Payer: Humana ChoiceCare |
$5,578.12
|
| Rate for Payer: Humana Medicare |
$3,293.78
|
| Rate for Payer: Lucent All Commercial |
$3,293.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,812.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,843.80
|
| Rate for Payer: PHP All Commercial |
$4,898.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,518.78
|
| Rate for Payer: Sagamore Health Network All Products |
$4,985.88
|
| Rate for Payer: Signature Care EPO |
$5,360.47
|
| Rate for Payer: Signature Care PPO |
$5,683.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,489.64
|
| Rate for Payer: United Healthcare Commercial |
$5,089.22
|
| Rate for Payer: United Healthcare Medicare |
$2,131.27
|
|
|
HC Z OXF PART LAT TIB E6 R
|
Facility
IP
|
$6,458.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,843.80 |
| Max. Negotiated Rate |
$6,006.31 |
| Rate for Payer: Aetna Commercial |
$5,580.06
|
| Rate for Payer: Cash Price |
$4,004.21
|
| Rate for Payer: Cigna All Commercial |
$5,573.60
|
| Rate for Payer: CORVEL All Commercial |
$6,006.31
|
| Rate for Payer: Coventry All Commercial |
$5,683.39
|
| Rate for Payer: Encore All Commercial |
$5,944.96
|
| Rate for Payer: Frontpath All Commercial |
$5,941.73
|
| Rate for Payer: Humana ChoiceCare |
$5,578.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,812.56
|
| Rate for Payer: PHCS All Commercial |
$4,843.80
|
| Rate for Payer: PHP All Commercial |
$4,898.05
|
| Rate for Payer: Sagamore Health Network All Products |
$4,985.88
|
| Rate for Payer: Signature Care EPO |
$5,360.47
|
| Rate for Payer: Signature Care PPO |
$5,683.39
|
| Rate for Payer: United Healthcare Commercial |
$5,089.22
|
|
|
HC Z PATELLA 40MM STD
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
|
HC Z PATELLA 40MM STD
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC Z PATELLA TRB METAL KIT
|
Facility
OP
|
$25,581.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$23,790.89 |
| Rate for Payer: Aetna Commercial |
$21,590.87
|
| Rate for Payer: Aetna Medicare |
$8,441.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8,441.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14,691.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15,991.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9,708.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9,286.12
|
| Rate for Payer: Cash Price |
$15,860.59
|
| Rate for Payer: Cash Price |
$15,860.59
|
| Rate for Payer: Centivo All Commercial |
$13,046.62
|
| Rate for Payer: Cigna All Commercial |
$22,076.92
|
| Rate for Payer: CORVEL All Commercial |
$23,790.89
|
| Rate for Payer: Coventry All Commercial |
$22,511.81
|
| Rate for Payer: Encore All Commercial |
$23,547.86
|
| Rate for Payer: Frontpath All Commercial |
$23,535.07
|
| Rate for Payer: Humana ChoiceCare |
$22,094.83
|
| Rate for Payer: Humana Medicare |
$13,046.62
|
| Rate for Payer: Lucent All Commercial |
$13,046.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23,023.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$19,186.20
|
| Rate for Payer: PHP All Commercial |
$19,401.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,976.82
|
| Rate for Payer: Sagamore Health Network All Products |
$19,749.00
|
| Rate for Payer: Signature Care EPO |
$21,232.73
|
| Rate for Payer: Signature Care PPO |
$22,511.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,744.36
|
| Rate for Payer: United Healthcare Commercial |
$20,158.30
|
| Rate for Payer: United Healthcare Medicare |
$8,441.93
|
|
|
HC Z PATELLA TRB METAL KIT
|
Facility
IP
|
$25,581.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19,186.20 |
| Max. Negotiated Rate |
$23,790.89 |
| Rate for Payer: Aetna Commercial |
$22,102.50
|
| Rate for Payer: Cash Price |
$15,860.59
|
| Rate for Payer: Cigna All Commercial |
$22,076.92
|
| Rate for Payer: CORVEL All Commercial |
$23,790.89
|
| Rate for Payer: Coventry All Commercial |
$22,511.81
|
| Rate for Payer: Encore All Commercial |
$23,547.86
|
| Rate for Payer: Frontpath All Commercial |
$23,535.07
|
| Rate for Payer: Humana ChoiceCare |
$22,094.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23,023.44
|
| Rate for Payer: PHCS All Commercial |
$19,186.20
|
| Rate for Payer: PHP All Commercial |
$19,401.09
|
| Rate for Payer: Sagamore Health Network All Products |
$19,749.00
|
| Rate for Payer: Signature Care EPO |
$21,232.73
|
| Rate for Payer: Signature Care PPO |
$22,511.81
|
| Rate for Payer: United Healthcare Commercial |
$20,158.30
|
|
|
HC Z PEEK ANCHOR 4.75 KNTLS
|
Facility
OP
|
$2,205.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,050.65 |
| Rate for Payer: Aetna Commercial |
$1,861.02
|
| Rate for Payer: Aetna Medicare |
$727.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$727.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,266.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,378.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$836.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$800.42
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Centivo All Commercial |
$1,124.55
|
| Rate for Payer: Cigna All Commercial |
$1,902.92
|
| Rate for Payer: CORVEL All Commercial |
$2,050.65
|
| Rate for Payer: Coventry All Commercial |
$1,940.40
|
| Rate for Payer: Encore All Commercial |
$2,029.70
|
| Rate for Payer: Frontpath All Commercial |
$2,028.60
|
| Rate for Payer: Humana ChoiceCare |
$1,904.46
|
| Rate for Payer: Humana Medicare |
$1,124.55
|
| Rate for Payer: Lucent All Commercial |
$1,124.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,984.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,653.75
|
| Rate for Payer: PHP All Commercial |
$1,672.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$859.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1,702.26
|
| Rate for Payer: Signature Care EPO |
$1,830.15
|
| Rate for Payer: Signature Care PPO |
$1,940.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,874.25
|
| Rate for Payer: United Healthcare Commercial |
$1,737.54
|
| Rate for Payer: United Healthcare Medicare |
$727.65
|
|
|
HC Z PEEK ANCHOR 4.75 KNTLS
|
Facility
IP
|
$2,205.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.75 |
| Max. Negotiated Rate |
$2,050.65 |
| Rate for Payer: Aetna Commercial |
$1,905.12
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cigna All Commercial |
$1,902.92
|
| Rate for Payer: CORVEL All Commercial |
$2,050.65
|
| Rate for Payer: Coventry All Commercial |
$1,940.40
|
| Rate for Payer: Encore All Commercial |
$2,029.70
|
| Rate for Payer: Frontpath All Commercial |
$2,028.60
|
| Rate for Payer: Humana ChoiceCare |
$1,904.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,984.50
|
| Rate for Payer: PHCS All Commercial |
$1,653.75
|
| Rate for Payer: PHP All Commercial |
$1,672.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,702.26
|
| Rate for Payer: Signature Care EPO |
$1,830.15
|
| Rate for Payer: Signature Care PPO |
$1,940.40
|
| Rate for Payer: United Healthcare Commercial |
$1,737.54
|
|
|
HC Z PEG 1.8X10 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
