|
HC Z STEM PRIMARY 9 MICRO
|
Facility
OP
|
$11,823.84
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,996.17 |
| Rate for Payer: Aetna Commercial |
$9,979.32
|
| Rate for Payer: Aetna Medicare |
$3,901.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,901.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,790.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,391.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,487.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,292.05
|
| Rate for Payer: Cash Price |
$7,330.78
|
| Rate for Payer: Cash Price |
$7,330.78
|
| Rate for Payer: Centivo All Commercial |
$6,030.16
|
| Rate for Payer: Cigna All Commercial |
$10,203.97
|
| Rate for Payer: CORVEL All Commercial |
$10,996.17
|
| Rate for Payer: Coventry All Commercial |
$10,404.98
|
| Rate for Payer: Encore All Commercial |
$10,883.84
|
| Rate for Payer: Frontpath All Commercial |
$10,877.93
|
| Rate for Payer: Humana ChoiceCare |
$10,212.25
|
| Rate for Payer: Humana Medicare |
$6,030.16
|
| Rate for Payer: Lucent All Commercial |
$6,030.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,867.88
|
| Rate for Payer: PHP All Commercial |
$8,967.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,611.30
|
| Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
| Rate for Payer: Signature Care EPO |
$9,813.79
|
| Rate for Payer: Signature Care PPO |
$10,404.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,050.26
|
| Rate for Payer: United Healthcare Commercial |
$9,317.19
|
| Rate for Payer: United Healthcare Medicare |
$3,901.87
|
|
|
HC Z STEM PRIMARY 9 MICRO
|
Facility
IP
|
$11,823.84
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,867.88 |
| Max. Negotiated Rate |
$10,996.17 |
| Rate for Payer: Aetna Commercial |
$10,215.80
|
| Rate for Payer: Cash Price |
$7,330.78
|
| Rate for Payer: Cigna All Commercial |
$10,203.97
|
| Rate for Payer: CORVEL All Commercial |
$10,996.17
|
| Rate for Payer: Coventry All Commercial |
$10,404.98
|
| Rate for Payer: Encore All Commercial |
$10,883.84
|
| Rate for Payer: Frontpath All Commercial |
$10,877.93
|
| Rate for Payer: Humana ChoiceCare |
$10,212.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,641.46
|
| Rate for Payer: PHCS All Commercial |
$8,867.88
|
| Rate for Payer: PHP All Commercial |
$8,967.20
|
| Rate for Payer: Sagamore Health Network All Products |
$9,128.00
|
| Rate for Payer: Signature Care EPO |
$9,813.79
|
| Rate for Payer: Signature Care PPO |
$10,404.98
|
| Rate for Payer: United Healthcare Commercial |
$9,317.19
|
|
|
HC Z SUBSCAP REPAIR KIT SM
|
Facility
IP
|
$1,831.25
|
|
| Hospital Charge Code |
41608105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,373.44 |
| Max. Negotiated Rate |
$1,703.06 |
| Rate for Payer: Aetna Commercial |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,135.38
|
| Rate for Payer: Cigna All Commercial |
$1,580.37
|
| Rate for Payer: CORVEL All Commercial |
$1,703.06
|
| Rate for Payer: Coventry All Commercial |
$1,611.50
|
| Rate for Payer: Encore All Commercial |
$1,685.67
|
| Rate for Payer: Frontpath All Commercial |
$1,684.75
|
| Rate for Payer: Humana ChoiceCare |
$1,581.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,648.12
|
| Rate for Payer: PHCS All Commercial |
$1,373.44
|
| Rate for Payer: PHP All Commercial |
$1,388.82
|
| Rate for Payer: Sagamore Health Network All Products |
$1,413.72
|
| Rate for Payer: Signature Care EPO |
$1,519.94
|
| Rate for Payer: Signature Care PPO |
$1,611.50
|
| Rate for Payer: United Healthcare Commercial |
$1,443.02
|
|
|
HC Z SUBSCAP REPAIR KIT SM
|
Facility
OP
|
$1,831.25
|
|
| Hospital Charge Code |
41608105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,703.06 |
| Rate for Payer: Aetna Commercial |
$1,545.58
|
| Rate for Payer: Aetna Medicare |
$604.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$604.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,051.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,144.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$694.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$664.74
|
| Rate for Payer: Cash Price |
$1,135.38
|
| Rate for Payer: Cash Price |
$1,135.38
|
| Rate for Payer: Centivo All Commercial |
$933.94
|
| Rate for Payer: Cigna All Commercial |
$1,580.37
|
| Rate for Payer: CORVEL All Commercial |
$1,703.06
|
| Rate for Payer: Coventry All Commercial |
$1,611.50
|
| Rate for Payer: Encore All Commercial |
$1,685.67
|
| Rate for Payer: Frontpath All Commercial |
$1,684.75
|
| Rate for Payer: Humana ChoiceCare |
$1,581.65
|
| Rate for Payer: Humana Medicare |
$933.94
|
| Rate for Payer: Lucent All Commercial |
$933.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,648.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,373.44
|
| Rate for Payer: PHP All Commercial |
$1,388.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$714.19
|
| Rate for Payer: Sagamore Health Network All Products |
$1,413.72
|
| Rate for Payer: Signature Care EPO |
$1,519.94
|
| Rate for Payer: Signature Care PPO |
$1,611.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,556.56
|
| Rate for Payer: United Healthcare Commercial |
$1,443.02
|
| Rate for Payer: United Healthcare Medicare |
$604.31
|
|
|
HC Z SUTURE ACHOR #2 MXBRD 4.5
|
Facility
OP
|
$1,750.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,477.00
|
| Rate for Payer: Aetna Medicare |
$577.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$577.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,005.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,093.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$664.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$635.25
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: Centivo All Commercial |
$892.50
|
| Rate for Payer: Cigna All Commercial |
$1,510.25
|
| Rate for Payer: CORVEL All Commercial |
$1,627.50
|
| Rate for Payer: Coventry All Commercial |
$1,540.00
|
| Rate for Payer: Encore All Commercial |
$1,610.88
|
| Rate for Payer: Frontpath All Commercial |
$1,610.00
|
| Rate for Payer: Humana ChoiceCare |
$1,511.48
|
| Rate for Payer: Humana Medicare |
$892.50
|
| Rate for Payer: Lucent All Commercial |
$892.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,575.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,312.50
|
| Rate for Payer: PHP All Commercial |
$1,327.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$682.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,351.00
|
| Rate for Payer: Signature Care EPO |
$1,452.50
|
| Rate for Payer: Signature Care PPO |
$1,540.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,487.50
|
| Rate for Payer: United Healthcare Commercial |
$1,379.00
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
|
|
HC Z SUTURE ACHOR #2 MXBRD 4.5
|
Facility
IP
|
$1,750.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: Cigna All Commercial |
$1,510.25
|
| Rate for Payer: CORVEL All Commercial |
$1,627.50
|
| Rate for Payer: Coventry All Commercial |
$1,540.00
|
| Rate for Payer: Encore All Commercial |
$1,610.88
|
| Rate for Payer: Frontpath All Commercial |
$1,610.00
|
| Rate for Payer: Humana ChoiceCare |
$1,511.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,575.00
|
| Rate for Payer: PHCS All Commercial |
$1,312.50
|
| Rate for Payer: PHP All Commercial |
$1,327.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,351.00
|
| Rate for Payer: Signature Care EPO |
$1,452.50
|
| Rate for Payer: Signature Care PPO |
$1,540.00
|
| Rate for Payer: United Healthcare Commercial |
$1,379.00
|
|
|
HC Z SUTURE ANCHOR 2 #2 M
|
Facility
OP
|
$1,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,477.00
|
| Rate for Payer: Aetna Medicare |
$577.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$577.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,005.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,093.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$664.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$635.25
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: Centivo All Commercial |
$892.50
|
| Rate for Payer: Cigna All Commercial |
$1,510.25
|
| Rate for Payer: CORVEL All Commercial |
$1,627.50
|
| Rate for Payer: Coventry All Commercial |
$1,540.00
|
| Rate for Payer: Encore All Commercial |
$1,610.88
|
| Rate for Payer: Frontpath All Commercial |
$1,610.00
|
| Rate for Payer: Humana ChoiceCare |
$1,511.48
|
| Rate for Payer: Humana Medicare |
$892.50
|
| Rate for Payer: Lucent All Commercial |
$892.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,575.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,312.50
|
| Rate for Payer: PHP All Commercial |
$1,327.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$682.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,351.00
|
| Rate for Payer: Signature Care EPO |
$1,452.50
|
| Rate for Payer: Signature Care PPO |
$1,540.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,487.50
|
| Rate for Payer: United Healthcare Commercial |
$1,379.00
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
|
|
HC Z SUTURE ANCHOR 2 #2 M
|
Facility
IP
|
$1,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: Cigna All Commercial |
$1,510.25
|
| Rate for Payer: CORVEL All Commercial |
$1,627.50
|
| Rate for Payer: Coventry All Commercial |
$1,540.00
|
| Rate for Payer: Encore All Commercial |
$1,610.88
|
| Rate for Payer: Frontpath All Commercial |
$1,610.00
|
| Rate for Payer: Humana ChoiceCare |
$1,511.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,575.00
|
| Rate for Payer: PHCS All Commercial |
$1,312.50
|
| Rate for Payer: PHP All Commercial |
$1,327.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,351.00
|
| Rate for Payer: Signature Care EPO |
$1,452.50
|
| Rate for Payer: Signature Care PPO |
$1,540.00
|
| Rate for Payer: United Healthcare Commercial |
$1,379.00
|
|
|
HC Z SUTURE ANCHOR 4.5
|
Facility
IP
|
$2,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.50 |
| Max. Negotiated Rate |
$1,906.50 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Cigna All Commercial |
$1,769.15
|
| Rate for Payer: CORVEL All Commercial |
$1,906.50
|
| Rate for Payer: Coventry All Commercial |
$1,804.00
|
| Rate for Payer: Encore All Commercial |
$1,887.02
|
| Rate for Payer: Frontpath All Commercial |
$1,886.00
|
| Rate for Payer: Humana ChoiceCare |
$1,770.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,845.00
|
| Rate for Payer: PHCS All Commercial |
$1,537.50
|
| Rate for Payer: PHP All Commercial |
$1,554.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,582.60
|
| Rate for Payer: Signature Care EPO |
$1,701.50
|
| Rate for Payer: Signature Care PPO |
$1,804.00
|
| Rate for Payer: United Healthcare Commercial |
$1,615.40
|
|
|
HC Z SUTURE ANCHOR 4.5
|
Facility
OP
|
$2,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,906.50 |
| Rate for Payer: Aetna Commercial |
$1,730.20
|
| Rate for Payer: Aetna Medicare |
$676.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$676.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,281.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$777.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$744.15
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Centivo All Commercial |
$1,045.50
|
| Rate for Payer: Cigna All Commercial |
$1,769.15
|
| Rate for Payer: CORVEL All Commercial |
$1,906.50
|
| Rate for Payer: Coventry All Commercial |
$1,804.00
|
| Rate for Payer: Encore All Commercial |
$1,887.02
|
| Rate for Payer: Frontpath All Commercial |
$1,886.00
|
| Rate for Payer: Humana ChoiceCare |
$1,770.58
|
| Rate for Payer: Humana Medicare |
$1,045.50
|
| Rate for Payer: Lucent All Commercial |
$1,045.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,845.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,537.50
|
| Rate for Payer: PHP All Commercial |
$1,554.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$799.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,582.60
|
| Rate for Payer: Signature Care EPO |
$1,701.50
|
| Rate for Payer: Signature Care PPO |
$1,804.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,742.50
|
| Rate for Payer: United Healthcare Commercial |
$1,615.40
|
| Rate for Payer: United Healthcare Medicare |
$676.50
|
|
|
HC Z SUTURE ANCHOR 6.5
|
Facility
IP
|
$2,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.50 |
| Max. Negotiated Rate |
$1,906.50 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Cigna All Commercial |
$1,769.15
|
| Rate for Payer: CORVEL All Commercial |
$1,906.50
|
| Rate for Payer: Coventry All Commercial |
$1,804.00
|
| Rate for Payer: Encore All Commercial |
$1,887.02
|
| Rate for Payer: Frontpath All Commercial |
$1,886.00
|
| Rate for Payer: Humana ChoiceCare |
$1,770.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,845.00
|
| Rate for Payer: PHCS All Commercial |
$1,537.50
|
| Rate for Payer: PHP All Commercial |
$1,554.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,582.60
|
| Rate for Payer: Signature Care EPO |
$1,701.50
|
| Rate for Payer: Signature Care PPO |
$1,804.00
|
| Rate for Payer: United Healthcare Commercial |
$1,615.40
|
|
|
HC Z SUTURE ANCHOR 6.5
|
Facility
OP
|
$2,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,906.50 |
| Rate for Payer: Aetna Commercial |
$1,730.20
|
| Rate for Payer: Aetna Medicare |
$676.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$676.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,281.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$777.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$744.15
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Centivo All Commercial |
$1,045.50
|
| Rate for Payer: Cigna All Commercial |
$1,769.15
|
| Rate for Payer: CORVEL All Commercial |
$1,906.50
|
| Rate for Payer: Coventry All Commercial |
$1,804.00
|
| Rate for Payer: Encore All Commercial |
$1,887.02
|
| Rate for Payer: Frontpath All Commercial |
$1,886.00
|
| Rate for Payer: Humana ChoiceCare |
$1,770.58
|
| Rate for Payer: Humana Medicare |
$1,045.50
|
| Rate for Payer: Lucent All Commercial |
$1,045.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,845.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,537.50
|
| Rate for Payer: PHP All Commercial |
$1,554.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$799.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,582.60
|
| Rate for Payer: Signature Care EPO |
$1,701.50
|
| Rate for Payer: Signature Care PPO |
$1,804.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,742.50
|
| Rate for Payer: United Healthcare Commercial |
$1,615.40
|
| Rate for Payer: United Healthcare Medicare |
$676.50
|
|
|
HC Z TAP 1.5 50 QC
|
Facility
IP
|
$512.75
|
|
| Hospital Charge Code |
41604263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.56 |
| Max. Negotiated Rate |
$476.86 |
| Rate for Payer: Aetna Commercial |
$443.02
|
| Rate for Payer: Cash Price |
$317.91
|
| Rate for Payer: Cigna All Commercial |
$442.50
|
| Rate for Payer: CORVEL All Commercial |
$476.86
|
| Rate for Payer: Coventry All Commercial |
$451.22
|
| Rate for Payer: Encore All Commercial |
$471.99
|
| Rate for Payer: Frontpath All Commercial |
$471.73
|
| Rate for Payer: Humana ChoiceCare |
$442.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.48
|
| Rate for Payer: PHCS All Commercial |
$384.56
|
| Rate for Payer: PHP All Commercial |
$388.87
|
| Rate for Payer: Sagamore Health Network All Products |
$395.84
|
| Rate for Payer: Signature Care EPO |
$425.58
|
| Rate for Payer: Signature Care PPO |
$451.22
|
| Rate for Payer: United Healthcare Commercial |
$404.05
|
|
|
HC Z TAP 1.5 50 QC
|
Facility
OP
|
$512.75
|
|
| Hospital Charge Code |
41604263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$476.86 |
| Rate for Payer: Aetna Commercial |
$432.76
|
| Rate for Payer: Aetna Medicare |
$169.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.13
|
| Rate for Payer: Cash Price |
$317.91
|
| Rate for Payer: Cash Price |
$317.91
|
| Rate for Payer: Centivo All Commercial |
$261.50
|
| Rate for Payer: Cigna All Commercial |
$442.50
|
| Rate for Payer: CORVEL All Commercial |
$476.86
|
| Rate for Payer: Coventry All Commercial |
$451.22
|
| Rate for Payer: Encore All Commercial |
$471.99
|
| Rate for Payer: Frontpath All Commercial |
$471.73
|
| Rate for Payer: Humana ChoiceCare |
$442.86
|
| Rate for Payer: Humana Medicare |
$261.50
|
| Rate for Payer: Lucent All Commercial |
$261.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$384.56
|
| Rate for Payer: PHP All Commercial |
$388.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.97
|
| Rate for Payer: Sagamore Health Network All Products |
$395.84
|
| Rate for Payer: Signature Care EPO |
$425.58
|
| Rate for Payer: Signature Care PPO |
$451.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.84
|
| Rate for Payer: United Healthcare Commercial |
$404.05
|
| Rate for Payer: United Healthcare Medicare |
$169.21
|
|
|
HC Z TAP 2.0 53 QC
|
Facility
IP
|
$512.75
|
|
| Hospital Charge Code |
41604264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.56 |
| Max. Negotiated Rate |
$476.86 |
| Rate for Payer: Aetna Commercial |
$443.02
|
| Rate for Payer: Cash Price |
$317.91
|
| Rate for Payer: Cigna All Commercial |
$442.50
|
| Rate for Payer: CORVEL All Commercial |
$476.86
|
| Rate for Payer: Coventry All Commercial |
$451.22
|
| Rate for Payer: Encore All Commercial |
$471.99
|
| Rate for Payer: Frontpath All Commercial |
$471.73
|
| Rate for Payer: Humana ChoiceCare |
$442.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.48
|
| Rate for Payer: PHCS All Commercial |
$384.56
|
| Rate for Payer: PHP All Commercial |
$388.87
|
| Rate for Payer: Sagamore Health Network All Products |
$395.84
|
| Rate for Payer: Signature Care EPO |
$425.58
|
| Rate for Payer: Signature Care PPO |
$451.22
|
| Rate for Payer: United Healthcare Commercial |
$404.05
|
|
|
HC Z TAP 2.0 53 QC
|
Facility
OP
|
$512.75
|
|
| Hospital Charge Code |
41604264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$476.86 |
| Rate for Payer: Aetna Commercial |
$432.76
|
| Rate for Payer: Aetna Medicare |
$169.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.13
|
| Rate for Payer: Cash Price |
$317.91
|
| Rate for Payer: Cash Price |
$317.91
|
| Rate for Payer: Centivo All Commercial |
$261.50
|
| Rate for Payer: Cigna All Commercial |
$442.50
|
| Rate for Payer: CORVEL All Commercial |
$476.86
|
| Rate for Payer: Coventry All Commercial |
$451.22
|
| Rate for Payer: Encore All Commercial |
$471.99
|
| Rate for Payer: Frontpath All Commercial |
$471.73
|
| Rate for Payer: Humana ChoiceCare |
$442.86
|
| Rate for Payer: Humana Medicare |
$261.50
|
| Rate for Payer: Lucent All Commercial |
$261.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$384.56
|
| Rate for Payer: PHP All Commercial |
$388.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.97
|
| Rate for Payer: Sagamore Health Network All Products |
$395.84
|
| Rate for Payer: Signature Care EPO |
$425.58
|
| Rate for Payer: Signature Care PPO |
$451.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.84
|
| Rate for Payer: United Healthcare Commercial |
$404.05
|
| Rate for Payer: United Healthcare Medicare |
$169.21
|
|
|
HC Z TAP 2.4X30 AO
|
Facility
OP
|
$1,200.00
|
|
| Hospital Charge Code |
41604330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$1,012.80
|
| Rate for Payer: Aetna Medicare |
$396.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$396.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$689.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$435.60
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Centivo All Commercial |
$612.00
|
| Rate for Payer: Cigna All Commercial |
$1,035.60
|
| Rate for Payer: CORVEL All Commercial |
$1,116.00
|
| Rate for Payer: Coventry All Commercial |
$1,056.00
|
| Rate for Payer: Encore All Commercial |
$1,104.60
|
| Rate for Payer: Frontpath All Commercial |
$1,104.00
|
| Rate for Payer: Humana ChoiceCare |
$1,036.44
|
| Rate for Payer: Humana Medicare |
$612.00
|
| Rate for Payer: Lucent All Commercial |
$612.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,080.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$900.00
|
| Rate for Payer: PHP All Commercial |
$910.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.00
|
| Rate for Payer: Sagamore Health Network All Products |
$926.40
|
| Rate for Payer: Signature Care EPO |
$996.00
|
| Rate for Payer: Signature Care PPO |
$1,056.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.00
|
| Rate for Payer: United Healthcare Commercial |
$945.60
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
|
|
HC Z TAP 2.4X30 AO
|
Facility
IP
|
$1,200.00
|
|
| Hospital Charge Code |
41604330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna All Commercial |
$1,035.60
|
| Rate for Payer: CORVEL All Commercial |
$1,116.00
|
| Rate for Payer: Coventry All Commercial |
$1,056.00
|
| Rate for Payer: Encore All Commercial |
$1,104.60
|
| Rate for Payer: Frontpath All Commercial |
$1,104.00
|
| Rate for Payer: Humana ChoiceCare |
$1,036.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,080.00
|
| Rate for Payer: PHCS All Commercial |
$900.00
|
| Rate for Payer: PHP All Commercial |
$910.08
|
| Rate for Payer: Sagamore Health Network All Products |
$926.40
|
| Rate for Payer: Signature Care EPO |
$996.00
|
| Rate for Payer: Signature Care PPO |
$1,056.00
|
| Rate for Payer: United Healthcare Commercial |
$945.60
|
|
|
HC Z TAP 2.7 100 QC
|
Facility
OP
|
$605.92
|
|
| Hospital Charge Code |
41604265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$563.51 |
| Rate for Payer: Aetna Commercial |
$511.40
|
| Rate for Payer: Aetna Medicare |
$199.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$199.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$347.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$378.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.95
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Centivo All Commercial |
$309.02
|
| Rate for Payer: Cigna All Commercial |
$522.91
|
| Rate for Payer: CORVEL All Commercial |
$563.51
|
| Rate for Payer: Coventry All Commercial |
$533.21
|
| Rate for Payer: Encore All Commercial |
$557.75
|
| Rate for Payer: Frontpath All Commercial |
$557.45
|
| Rate for Payer: Humana ChoiceCare |
$523.33
|
| Rate for Payer: Humana Medicare |
$309.02
|
| Rate for Payer: Lucent All Commercial |
$309.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.33
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$454.44
|
| Rate for Payer: PHP All Commercial |
$459.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.31
|
| Rate for Payer: Sagamore Health Network All Products |
$467.77
|
| Rate for Payer: Signature Care EPO |
$502.91
|
| Rate for Payer: Signature Care PPO |
$533.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$515.03
|
| Rate for Payer: United Healthcare Commercial |
$477.46
|
| Rate for Payer: United Healthcare Medicare |
$199.95
|
|
|
HC Z TAP 2.7 100 QC
|
Facility
IP
|
$605.92
|
|
| Hospital Charge Code |
41604265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.44 |
| Max. Negotiated Rate |
$563.51 |
| Rate for Payer: Aetna Commercial |
$523.51
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Cigna All Commercial |
$522.91
|
| Rate for Payer: CORVEL All Commercial |
$563.51
|
| Rate for Payer: Coventry All Commercial |
$533.21
|
| Rate for Payer: Encore All Commercial |
$557.75
|
| Rate for Payer: Frontpath All Commercial |
$557.45
|
| Rate for Payer: Humana ChoiceCare |
$523.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.33
|
| Rate for Payer: PHCS All Commercial |
$454.44
|
| Rate for Payer: PHP All Commercial |
$459.53
|
| Rate for Payer: Sagamore Health Network All Products |
$467.77
|
| Rate for Payer: Signature Care EPO |
$502.91
|
| Rate for Payer: Signature Care PPO |
$533.21
|
| Rate for Payer: United Healthcare Commercial |
$477.46
|
|
|
HC Z TAP 2.7 LOCK QC
|
Facility
IP
|
$832.25
|
|
| Hospital Charge Code |
41604136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.19 |
| Max. Negotiated Rate |
$773.99 |
| Rate for Payer: Aetna Commercial |
$719.06
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna All Commercial |
$718.23
|
| Rate for Payer: CORVEL All Commercial |
$773.99
|
| Rate for Payer: Coventry All Commercial |
$732.38
|
| Rate for Payer: Encore All Commercial |
$766.09
|
| Rate for Payer: Frontpath All Commercial |
$765.67
|
| Rate for Payer: Humana ChoiceCare |
$718.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$749.02
|
| Rate for Payer: PHCS All Commercial |
$624.19
|
| Rate for Payer: PHP All Commercial |
$631.18
|
| Rate for Payer: Sagamore Health Network All Products |
$642.50
|
| Rate for Payer: Signature Care EPO |
$690.77
|
| Rate for Payer: Signature Care PPO |
$732.38
|
| Rate for Payer: United Healthcare Commercial |
$655.81
|
|
|
HC Z TAP 2.7 LOCK QC
|
Facility
OP
|
$832.25
|
|
| Hospital Charge Code |
41604136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$773.99 |
| Rate for Payer: Aetna Commercial |
$702.42
|
| Rate for Payer: Aetna Medicare |
$274.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$274.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$477.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$520.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$302.11
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Centivo All Commercial |
$424.45
|
| Rate for Payer: Cigna All Commercial |
$718.23
|
| Rate for Payer: CORVEL All Commercial |
$773.99
|
| Rate for Payer: Coventry All Commercial |
$732.38
|
| Rate for Payer: Encore All Commercial |
$766.09
|
| Rate for Payer: Frontpath All Commercial |
$765.67
|
| Rate for Payer: Humana ChoiceCare |
$718.81
|
| Rate for Payer: Humana Medicare |
$424.45
|
| Rate for Payer: Lucent All Commercial |
$424.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$749.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$624.19
|
| Rate for Payer: PHP All Commercial |
$631.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$324.58
|
| Rate for Payer: Sagamore Health Network All Products |
$642.50
|
| Rate for Payer: Signature Care EPO |
$690.77
|
| Rate for Payer: Signature Care PPO |
$732.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$707.41
|
| Rate for Payer: United Healthcare Commercial |
$655.81
|
| Rate for Payer: United Healthcare Medicare |
$274.64
|
|
|
HC Z TAP 3.5 110 QC
|
Facility
OP
|
$605.92
|
|
| Hospital Charge Code |
41604137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$563.51 |
| Rate for Payer: Aetna Commercial |
$511.40
|
| Rate for Payer: Aetna Medicare |
$199.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$199.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$347.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$378.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.95
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Centivo All Commercial |
$309.02
|
| Rate for Payer: Cigna All Commercial |
$522.91
|
| Rate for Payer: CORVEL All Commercial |
$563.51
|
| Rate for Payer: Coventry All Commercial |
$533.21
|
| Rate for Payer: Encore All Commercial |
$557.75
|
| Rate for Payer: Frontpath All Commercial |
$557.45
|
| Rate for Payer: Humana ChoiceCare |
$523.33
|
| Rate for Payer: Humana Medicare |
$309.02
|
| Rate for Payer: Lucent All Commercial |
$309.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.33
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$454.44
|
| Rate for Payer: PHP All Commercial |
$459.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.31
|
| Rate for Payer: Sagamore Health Network All Products |
$467.77
|
| Rate for Payer: Signature Care EPO |
$502.91
|
| Rate for Payer: Signature Care PPO |
$533.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$515.03
|
| Rate for Payer: United Healthcare Commercial |
$477.46
|
| Rate for Payer: United Healthcare Medicare |
$199.95
|
|
|
HC Z TAP 3.5 110 QC
|
Facility
IP
|
$605.92
|
|
| Hospital Charge Code |
41604137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.44 |
| Max. Negotiated Rate |
$563.51 |
| Rate for Payer: Aetna Commercial |
$523.51
|
| Rate for Payer: Cash Price |
$375.67
|
| Rate for Payer: Cigna All Commercial |
$522.91
|
| Rate for Payer: CORVEL All Commercial |
$563.51
|
| Rate for Payer: Coventry All Commercial |
$533.21
|
| Rate for Payer: Encore All Commercial |
$557.75
|
| Rate for Payer: Frontpath All Commercial |
$557.45
|
| Rate for Payer: Humana ChoiceCare |
$523.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.33
|
| Rate for Payer: PHCS All Commercial |
$454.44
|
| Rate for Payer: PHP All Commercial |
$459.53
|
| Rate for Payer: Sagamore Health Network All Products |
$467.77
|
| Rate for Payer: Signature Care EPO |
$502.91
|
| Rate for Payer: Signature Care PPO |
$533.21
|
| Rate for Payer: United Healthcare Commercial |
$477.46
|
|
|
HC Z TAP 3.5 CANN QC
|
Facility
IP
|
$2,197.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,647.86 |
| Max. Negotiated Rate |
$2,043.35 |
| Rate for Payer: Aetna Commercial |
$1,898.34
|
| Rate for Payer: Cash Price |
$1,362.23
|
| Rate for Payer: Cigna All Commercial |
$1,896.14
|
| Rate for Payer: CORVEL All Commercial |
$2,043.35
|
| Rate for Payer: Coventry All Commercial |
$1,933.49
|
| Rate for Payer: Encore All Commercial |
$2,022.48
|
| Rate for Payer: Frontpath All Commercial |
$2,021.38
|
| Rate for Payer: Humana ChoiceCare |
$1,897.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,977.44
|
| Rate for Payer: PHCS All Commercial |
$1,647.86
|
| Rate for Payer: PHP All Commercial |
$1,666.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,696.20
|
| Rate for Payer: Signature Care EPO |
$1,823.63
|
| Rate for Payer: Signature Care PPO |
$1,933.49
|
| Rate for Payer: United Healthcare Commercial |
$1,731.35
|
|
