|
HC Z VANGUARD STD PAT 31 3PEG
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606224
|
|
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 VANGUARD STD PAT 31 3PEG
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606224
|
|
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 VANGUARD STD PAT 34 3PEG
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606225
|
|
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 VANGUARD STD PAT 34 3PEG
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606225
|
|
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 VANGUARD THN PAT 28 3 PEG
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606985
|
|
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 VANGUARD THN PAT 28 3 PEG
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606985
|
|
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 VANGUARD THN PAT 31 3PEG
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606959
|
|
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 VANGUARD THN PAT 31 3PEG
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41606959
|
|
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 VANGUARD THN PAT 34 3 PEG
|
Facility
IP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607056
|
|
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 VANGUARD THN PAT 34 3 PEG
|
Facility
OP
|
$2,649.60
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607056
|
|
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 VERSA TI STD TAPER
|
Facility
IP
|
$986.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.02 |
| Max. Negotiated Rate |
$917.63 |
| Rate for Payer: Aetna Commercial |
$852.51
|
| Rate for Payer: Cash Price |
$611.75
|
| Rate for Payer: Cigna All Commercial |
$851.52
|
| Rate for Payer: CORVEL All Commercial |
$917.63
|
| Rate for Payer: Coventry All Commercial |
$868.30
|
| Rate for Payer: Encore All Commercial |
$908.26
|
| Rate for Payer: Frontpath All Commercial |
$907.76
|
| Rate for Payer: Humana ChoiceCare |
$852.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$888.03
|
| Rate for Payer: PHCS All Commercial |
$740.02
|
| Rate for Payer: PHP All Commercial |
$748.31
|
| Rate for Payer: Sagamore Health Network All Products |
$761.73
|
| Rate for Payer: Signature Care EPO |
$818.96
|
| Rate for Payer: Signature Care PPO |
$868.30
|
| Rate for Payer: United Healthcare Commercial |
$777.52
|
|
|
HC Z VERSA TI STD TAPER
|
Facility
OP
|
$986.70
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.61 |
| Max. Negotiated Rate |
$917.63 |
| Rate for Payer: Aetna Commercial |
$832.77
|
| Rate for Payer: Aetna Medicare |
$325.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$566.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$374.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$358.17
|
| Rate for Payer: Cash Price |
$611.75
|
| Rate for Payer: Cash Price |
$611.75
|
| Rate for Payer: Centivo All Commercial |
$503.22
|
| Rate for Payer: Cigna All Commercial |
$851.52
|
| Rate for Payer: CORVEL All Commercial |
$917.63
|
| Rate for Payer: Coventry All Commercial |
$868.30
|
| Rate for Payer: Encore All Commercial |
$908.26
|
| Rate for Payer: Frontpath All Commercial |
$907.76
|
| Rate for Payer: Humana ChoiceCare |
$852.21
|
| Rate for Payer: Humana Medicare |
$503.22
|
| Rate for Payer: Lucent All Commercial |
$503.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$888.03
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$740.02
|
| Rate for Payer: PHP All Commercial |
$748.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$384.81
|
| Rate for Payer: Sagamore Health Network All Products |
$761.73
|
| Rate for Payer: Signature Care EPO |
$818.96
|
| Rate for Payer: Signature Care PPO |
$868.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$838.70
|
| Rate for Payer: United Healthcare Commercial |
$777.52
|
| Rate for Payer: United Healthcare Medicare |
$325.61
|
|
|
HC Z VERSYS DT CENTRALIZER 10 QD
|
Facility
OP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.39 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$407.65
|
| Rate for Payer: Aetna Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$277.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.33
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Centivo All Commercial |
$246.33
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Humana Medicare |
$246.33
|
| Rate for Payer: Lucent All Commercial |
$246.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.37
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.55
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
| Rate for Payer: United Healthcare Medicare |
$159.39
|
|
|
HC Z VERSYS DT CENTRALIZER 10 QD
|
Facility
IP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$449.19 |
| Rate for Payer: Aetna Commercial |
$417.31
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
|
|
HC Z VERSYS DT CENTRALIZER 11 OD
|
Facility
OP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.39 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$407.65
|
| Rate for Payer: Aetna Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$277.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.33
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Centivo All Commercial |
$246.33
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Humana Medicare |
$246.33
|
| Rate for Payer: Lucent All Commercial |
$246.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.37
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.55
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
| Rate for Payer: United Healthcare Medicare |
$159.39
|
|
|
HC Z VERSYS DT CENTRALIZER 11 OD
|
Facility
IP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$449.19 |
| Rate for Payer: Aetna Commercial |
$417.31
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
|
|
HC Z VERSYS DT CENTRALIZER 12 OD
|
Facility
IP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$449.19 |
| Rate for Payer: Aetna Commercial |
$417.31
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
|
|
HC Z VERSYS DT CENTRALIZER 12 OD
|
Facility
OP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.39 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$407.65
|
| Rate for Payer: Aetna Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$277.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.33
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Centivo All Commercial |
$246.33
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Humana Medicare |
$246.33
|
| Rate for Payer: Lucent All Commercial |
$246.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.37
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.55
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
| Rate for Payer: United Healthcare Medicare |
$159.39
|
|
|
HC Z VERSYS DT CENTRALIZER 13 OD
|
Facility
OP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.39 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$407.65
|
| Rate for Payer: Aetna Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$277.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.33
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Centivo All Commercial |
$246.33
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Humana Medicare |
$246.33
|
| Rate for Payer: Lucent All Commercial |
$246.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.37
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.55
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
| Rate for Payer: United Healthcare Medicare |
$159.39
|
|
|
HC Z VERSYS DT CENTRALIZER 13 OD
|
Facility
IP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41604658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$449.19 |
| Rate for Payer: Aetna Commercial |
$417.31
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
|
|
HC Z VERSYS DT CENTRALIZER 15 OD
|
Facility
OP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.39 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$407.65
|
| Rate for Payer: Aetna Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$277.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.33
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Centivo All Commercial |
$246.33
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Humana Medicare |
$246.33
|
| Rate for Payer: Lucent All Commercial |
$246.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.37
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.55
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
| Rate for Payer: United Healthcare Medicare |
$159.39
|
|
|
HC Z VERSYS DT CENTRALIZER 15 OD
|
Facility
IP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41607133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$449.19 |
| Rate for Payer: Aetna Commercial |
$417.31
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
|
|
HC Z VERSYS DT CENTRALIZER 9 OD
|
Facility
OP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.39 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$407.65
|
| Rate for Payer: Aetna Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$277.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.33
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Centivo All Commercial |
$246.33
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Humana Medicare |
$246.33
|
| Rate for Payer: Lucent All Commercial |
$246.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$188.37
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.55
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
| Rate for Payer: United Healthcare Medicare |
$159.39
|
|
|
HC Z VERSYS DT CENTRALIZER 9 OD
|
Facility
IP
|
$483.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41603985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$449.19 |
| Rate for Payer: Aetna Commercial |
$417.31
|
| Rate for Payer: Cash Price |
$299.46
|
| Rate for Payer: Cigna All Commercial |
$416.83
|
| Rate for Payer: CORVEL All Commercial |
$449.19
|
| Rate for Payer: Coventry All Commercial |
$425.04
|
| Rate for Payer: Encore All Commercial |
$444.60
|
| Rate for Payer: Frontpath All Commercial |
$444.36
|
| Rate for Payer: Humana ChoiceCare |
$417.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.70
|
| Rate for Payer: PHCS All Commercial |
$362.25
|
| Rate for Payer: PHP All Commercial |
$366.31
|
| Rate for Payer: Sagamore Health Network All Products |
$372.88
|
| Rate for Payer: Signature Care EPO |
$400.89
|
| Rate for Payer: Signature Care PPO |
$425.04
|
| Rate for Payer: United Healthcare Commercial |
$380.60
|
|
|
HC Z VNGD AS TIB BRG 10X67
|
Facility
IP
|
$7,525.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.78 |
| Max. Negotiated Rate |
$6,998.29 |
| Rate for Payer: Aetna Commercial |
$6,501.63
|
| Rate for Payer: Cash Price |
$4,665.53
|
| Rate for Payer: Cigna All Commercial |
$6,494.11
|
| Rate for Payer: CORVEL All Commercial |
$6,998.29
|
| Rate for Payer: Coventry All Commercial |
$6,622.04
|
| Rate for Payer: Encore All Commercial |
$6,926.80
|
| Rate for Payer: Frontpath All Commercial |
$6,923.04
|
| Rate for Payer: Humana ChoiceCare |
$6,499.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,772.54
|
| Rate for Payer: PHCS All Commercial |
$5,643.78
|
| Rate for Payer: PHP All Commercial |
$5,706.99
|
| Rate for Payer: Sagamore Health Network All Products |
$5,809.33
|
| Rate for Payer: Signature Care EPO |
$6,245.78
|
| Rate for Payer: Signature Care PPO |
$6,622.04
|
| Rate for Payer: United Healthcare Commercial |
$5,929.73
|
|
