|
HC AR PEEK SWVLK 4.75 W/BL
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,566.08
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.89
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
|
|
HC AR PEEK SWVLK 4.75 W/BL
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,506.68
|
| Rate for Payer: Aetna Medicare |
$950.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$920.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,092.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,045.44
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Centivo All Commercial |
$1,615.68
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.89
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Humana Medicare |
$950.40
|
| Rate for Payer: Lucent All Commercial |
$1,615.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,158.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
| Rate for Payer: United Healthcare Medicare |
$950.40
|
|
|
HC AR PEEK SWVLK SECONDARY FIX
|
Facility
|
IP
|
$4,352.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,264.30 |
| Max. Negotiated Rate |
$4,047.73 |
| Rate for Payer: Aetna Commercial |
$3,760.47
|
| Rate for Payer: Cash Price |
$2,611.44
|
| Rate for Payer: Cigna All Commercial |
$3,756.12
|
| Rate for Payer: CORVEL All Commercial |
$4,047.73
|
| Rate for Payer: Coventry All Commercial |
$3,830.11
|
| Rate for Payer: Encore All Commercial |
$4,006.38
|
| Rate for Payer: Frontpath All Commercial |
$4,004.21
|
| Rate for Payer: Humana ChoiceCare |
$3,759.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,917.16
|
| Rate for Payer: PHCS All Commercial |
$3,264.30
|
| Rate for Payer: PHP All Commercial |
$3,300.86
|
| Rate for Payer: Sagamore Health Network All Products |
$3,360.05
|
| Rate for Payer: Signature Care EPO |
$3,612.49
|
| Rate for Payer: Signature Care PPO |
$3,830.11
|
| Rate for Payer: United Healthcare Commercial |
$3,429.69
|
|
|
HC AR PEEK SWVLK SECONDARY FIX
|
Facility
|
OP
|
$4,352.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,047.73 |
| Rate for Payer: Aetna Commercial |
$3,673.43
|
| Rate for Payer: Aetna Medicare |
$1,392.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,349.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,499.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,720.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,601.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,532.04
|
| Rate for Payer: Cash Price |
$2,611.44
|
| Rate for Payer: Cash Price |
$2,611.44
|
| Rate for Payer: Centivo All Commercial |
$2,367.71
|
| Rate for Payer: Cigna All Commercial |
$3,756.12
|
| Rate for Payer: CORVEL All Commercial |
$4,047.73
|
| Rate for Payer: Coventry All Commercial |
$3,830.11
|
| Rate for Payer: Encore All Commercial |
$4,006.38
|
| Rate for Payer: Frontpath All Commercial |
$4,004.21
|
| Rate for Payer: Humana ChoiceCare |
$3,759.17
|
| Rate for Payer: Humana Medicare |
$1,392.77
|
| Rate for Payer: Lucent All Commercial |
$2,367.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,917.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,264.30
|
| Rate for Payer: PHP All Commercial |
$3,300.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,697.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,360.05
|
| Rate for Payer: Signature Care EPO |
$3,612.49
|
| Rate for Payer: Signature Care PPO |
$3,830.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,699.54
|
| Rate for Payer: United Healthcare Commercial |
$3,429.69
|
| Rate for Payer: United Healthcare Medicare |
$1,392.77
|
|
|
HC AR PERC INST KIT 2.9 PUSH LK
|
Facility
|
IP
|
$1,210.00
|
|
| Hospital Charge Code |
41606210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$907.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,045.44
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
|
|
HC AR PERC INST KIT 2.9 PUSH LK
|
Facility
|
OP
|
$1,210.00
|
|
| Hospital Charge Code |
41606210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,021.24
|
| Rate for Payer: Aetna Medicare |
$387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$375.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$694.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$756.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.92
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Centivo All Commercial |
$658.24
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.81
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Humana Medicare |
$387.20
|
| Rate for Payer: Lucent All Commercial |
$658.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$471.90
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,028.50
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
| Rate for Payer: United Healthcare Medicare |
$387.20
|
|
|
HC AR PLATE 8H TUB LOCK
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$1,909.44
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cigna All Commercial |
$1,907.23
|
| Rate for Payer: CORVEL All Commercial |
$2,055.30
|
| Rate for Payer: Coventry All Commercial |
$1,944.80
|
| Rate for Payer: Encore All Commercial |
$2,034.31
|
| Rate for Payer: Frontpath All Commercial |
$2,033.20
|
| Rate for Payer: Humana ChoiceCare |
$1,908.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,989.00
|
| Rate for Payer: PHCS All Commercial |
$1,657.50
|
| Rate for Payer: PHP All Commercial |
$1,676.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,706.12
|
| Rate for Payer: Signature Care EPO |
$1,834.30
|
| Rate for Payer: Signature Care PPO |
$1,944.80
|
| Rate for Payer: United Healthcare Commercial |
$1,741.48
|
|
|
HC AR PLATE 8H TUB LOCK
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$1,865.24
|
| Rate for Payer: Aetna Medicare |
$707.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$685.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,269.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,381.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$813.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$777.92
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Centivo All Commercial |
$1,202.24
|
| Rate for Payer: Cigna All Commercial |
$1,907.23
|
| Rate for Payer: CORVEL All Commercial |
$2,055.30
|
| Rate for Payer: Coventry All Commercial |
$1,944.80
|
| Rate for Payer: Encore All Commercial |
$2,034.31
|
| Rate for Payer: Frontpath All Commercial |
$2,033.20
|
| Rate for Payer: Humana ChoiceCare |
$1,908.78
|
| Rate for Payer: Humana Medicare |
$707.20
|
| Rate for Payer: Lucent All Commercial |
$1,202.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,989.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,657.50
|
| Rate for Payer: PHP All Commercial |
$1,676.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$861.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,706.12
|
| Rate for Payer: Signature Care EPO |
$1,834.30
|
| Rate for Payer: Signature Care PPO |
$1,944.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare Commercial |
$1,741.48
|
| Rate for Payer: United Healthcare Medicare |
$707.20
|
|
|
HC AR PLATE DIST FIB 12 LOCK R
|
Facility
|
OP
|
$5,641.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,246.32 |
| Rate for Payer: Aetna Commercial |
$4,761.17
|
| Rate for Payer: Aetna Medicare |
$1,805.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,748.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,239.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,526.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,075.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,985.70
|
| Rate for Payer: Cash Price |
$3,384.72
|
| Rate for Payer: Cash Price |
$3,384.72
|
| Rate for Payer: Centivo All Commercial |
$3,068.81
|
| Rate for Payer: Cigna All Commercial |
$4,868.36
|
| Rate for Payer: CORVEL All Commercial |
$5,246.32
|
| Rate for Payer: Coventry All Commercial |
$4,964.26
|
| Rate for Payer: Encore All Commercial |
$5,192.72
|
| Rate for Payer: Frontpath All Commercial |
$5,189.90
|
| Rate for Payer: Humana ChoiceCare |
$4,872.30
|
| Rate for Payer: Humana Medicare |
$1,805.18
|
| Rate for Payer: Lucent All Commercial |
$3,068.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,077.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,230.90
|
| Rate for Payer: PHP All Commercial |
$4,278.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,200.07
|
| Rate for Payer: Sagamore Health Network All Products |
$4,355.01
|
| Rate for Payer: Signature Care EPO |
$4,682.20
|
| Rate for Payer: Signature Care PPO |
$4,964.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,795.02
|
| Rate for Payer: United Healthcare Commercial |
$4,445.27
|
| Rate for Payer: United Healthcare Medicare |
$1,805.18
|
|
|
HC AR PLATE DIST FIB 12 LOCK R
|
Facility
|
IP
|
$5,641.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,230.90 |
| Max. Negotiated Rate |
$5,246.32 |
| Rate for Payer: Aetna Commercial |
$4,874.00
|
| Rate for Payer: Cash Price |
$3,384.72
|
| Rate for Payer: Cigna All Commercial |
$4,868.36
|
| Rate for Payer: CORVEL All Commercial |
$5,246.32
|
| Rate for Payer: Coventry All Commercial |
$4,964.26
|
| Rate for Payer: Encore All Commercial |
$5,192.72
|
| Rate for Payer: Frontpath All Commercial |
$5,189.90
|
| Rate for Payer: Humana ChoiceCare |
$4,872.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,077.08
|
| Rate for Payer: PHCS All Commercial |
$4,230.90
|
| Rate for Payer: PHP All Commercial |
$4,278.29
|
| Rate for Payer: Sagamore Health Network All Products |
$4,355.01
|
| Rate for Payer: Signature Care EPO |
$4,682.20
|
| Rate for Payer: Signature Care PPO |
$4,964.26
|
| Rate for Payer: United Healthcare Commercial |
$4,445.27
|
|
|
HC AR PLATE DIST FIB 4H LOCK L
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,038.40
|
| Rate for Payer: Aetna Medicare |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,116.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,067.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,250.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,324.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,267.20
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Centivo All Commercial |
$1,958.40
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Humana Medicare |
$1,152.00
|
| Rate for Payer: Lucent All Commercial |
$1,958.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,404.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,060.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
| Rate for Payer: United Healthcare Medicare |
$1,152.00
|
|
|
HC AR PLATE DIST FIB 4H LOCK L
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
|
|
HC AR PLATE DIST FIB 5H LOCK L
|
Facility
|
IP
|
$4,201.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,150.90 |
| Max. Negotiated Rate |
$3,907.12 |
| Rate for Payer: Aetna Commercial |
$3,629.84
|
| Rate for Payer: Cash Price |
$2,520.72
|
| Rate for Payer: Cigna All Commercial |
$3,625.64
|
| Rate for Payer: CORVEL All Commercial |
$3,907.12
|
| Rate for Payer: Coventry All Commercial |
$3,697.06
|
| Rate for Payer: Encore All Commercial |
$3,867.20
|
| Rate for Payer: Frontpath All Commercial |
$3,865.10
|
| Rate for Payer: Humana ChoiceCare |
$3,628.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,781.08
|
| Rate for Payer: PHCS All Commercial |
$3,150.90
|
| Rate for Payer: PHP All Commercial |
$3,186.19
|
| Rate for Payer: Sagamore Health Network All Products |
$3,243.33
|
| Rate for Payer: Signature Care EPO |
$3,487.00
|
| Rate for Payer: Signature Care PPO |
$3,697.06
|
| Rate for Payer: United Healthcare Commercial |
$3,310.55
|
|
|
HC AR PLATE DIST FIB 5H LOCK L
|
Facility
|
OP
|
$4,201.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,907.12 |
| Rate for Payer: Aetna Commercial |
$3,545.81
|
| Rate for Payer: Aetna Medicare |
$1,344.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,302.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,412.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,626.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,546.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,478.82
|
| Rate for Payer: Cash Price |
$2,520.72
|
| Rate for Payer: Cash Price |
$2,520.72
|
| Rate for Payer: Centivo All Commercial |
$2,285.45
|
| Rate for Payer: Cigna All Commercial |
$3,625.64
|
| Rate for Payer: CORVEL All Commercial |
$3,907.12
|
| Rate for Payer: Coventry All Commercial |
$3,697.06
|
| Rate for Payer: Encore All Commercial |
$3,867.20
|
| Rate for Payer: Frontpath All Commercial |
$3,865.10
|
| Rate for Payer: Humana ChoiceCare |
$3,628.58
|
| Rate for Payer: Humana Medicare |
$1,344.38
|
| Rate for Payer: Lucent All Commercial |
$2,285.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,781.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,150.90
|
| Rate for Payer: PHP All Commercial |
$3,186.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,638.47
|
| Rate for Payer: Sagamore Health Network All Products |
$3,243.33
|
| Rate for Payer: Signature Care EPO |
$3,487.00
|
| Rate for Payer: Signature Care PPO |
$3,697.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,571.02
|
| Rate for Payer: United Healthcare Commercial |
$3,310.55
|
| Rate for Payer: United Healthcare Medicare |
$1,344.38
|
|
|
HC AR PLATE DIST FIB 5H LOCK R
|
Facility
|
OP
|
$4,201.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,907.12 |
| Rate for Payer: Aetna Commercial |
$3,545.81
|
| Rate for Payer: Aetna Medicare |
$1,344.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,302.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,412.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,626.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,546.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,478.82
|
| Rate for Payer: Cash Price |
$2,520.72
|
| Rate for Payer: Cash Price |
$2,520.72
|
| Rate for Payer: Centivo All Commercial |
$2,285.45
|
| Rate for Payer: Cigna All Commercial |
$3,625.64
|
| Rate for Payer: CORVEL All Commercial |
$3,907.12
|
| Rate for Payer: Coventry All Commercial |
$3,697.06
|
| Rate for Payer: Encore All Commercial |
$3,867.20
|
| Rate for Payer: Frontpath All Commercial |
$3,865.10
|
| Rate for Payer: Humana ChoiceCare |
$3,628.58
|
| Rate for Payer: Humana Medicare |
$1,344.38
|
| Rate for Payer: Lucent All Commercial |
$2,285.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,781.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,150.90
|
| Rate for Payer: PHP All Commercial |
$3,186.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,638.47
|
| Rate for Payer: Sagamore Health Network All Products |
$3,243.33
|
| Rate for Payer: Signature Care EPO |
$3,487.00
|
| Rate for Payer: Signature Care PPO |
$3,697.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,571.02
|
| Rate for Payer: United Healthcare Commercial |
$3,310.55
|
| Rate for Payer: United Healthcare Medicare |
$1,344.38
|
|
|
HC AR PLATE DIST FIB 5H LOCK R
|
Facility
|
IP
|
$4,201.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,150.90 |
| Max. Negotiated Rate |
$3,907.12 |
| Rate for Payer: Aetna Commercial |
$3,629.84
|
| Rate for Payer: Cash Price |
$2,520.72
|
| Rate for Payer: Cigna All Commercial |
$3,625.64
|
| Rate for Payer: CORVEL All Commercial |
$3,907.12
|
| Rate for Payer: Coventry All Commercial |
$3,697.06
|
| Rate for Payer: Encore All Commercial |
$3,867.20
|
| Rate for Payer: Frontpath All Commercial |
$3,865.10
|
| Rate for Payer: Humana ChoiceCare |
$3,628.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,781.08
|
| Rate for Payer: PHCS All Commercial |
$3,150.90
|
| Rate for Payer: PHP All Commercial |
$3,186.19
|
| Rate for Payer: Sagamore Health Network All Products |
$3,243.33
|
| Rate for Payer: Signature Care EPO |
$3,487.00
|
| Rate for Payer: Signature Care PPO |
$3,697.06
|
| Rate for Payer: United Healthcare Commercial |
$3,310.55
|
|
|
HC AR PLATE DIST FIB 6H LOCK L
|
Facility
|
OP
|
$4,651.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,325.62 |
| Rate for Payer: Aetna Commercial |
$3,925.61
|
| Rate for Payer: Aetna Medicare |
$1,488.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,441.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,671.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,907.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,711.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,637.22
|
| Rate for Payer: Cash Price |
$2,790.72
|
| Rate for Payer: Cash Price |
$2,790.72
|
| Rate for Payer: Centivo All Commercial |
$2,530.25
|
| Rate for Payer: Cigna All Commercial |
$4,013.99
|
| Rate for Payer: CORVEL All Commercial |
$4,325.62
|
| Rate for Payer: Coventry All Commercial |
$4,093.06
|
| Rate for Payer: Encore All Commercial |
$4,281.43
|
| Rate for Payer: Frontpath All Commercial |
$4,279.10
|
| Rate for Payer: Humana ChoiceCare |
$4,017.24
|
| Rate for Payer: Humana Medicare |
$1,488.38
|
| Rate for Payer: Lucent All Commercial |
$2,530.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,186.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,488.40
|
| Rate for Payer: PHP All Commercial |
$3,527.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,813.97
|
| Rate for Payer: Sagamore Health Network All Products |
$3,590.73
|
| Rate for Payer: Signature Care EPO |
$3,860.50
|
| Rate for Payer: Signature Care PPO |
$4,093.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,953.52
|
| Rate for Payer: United Healthcare Commercial |
$3,665.15
|
| Rate for Payer: United Healthcare Medicare |
$1,488.38
|
|
|
HC AR PLATE DIST FIB 6H LOCK L
|
Facility
|
IP
|
$4,651.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,488.40 |
| Max. Negotiated Rate |
$4,325.62 |
| Rate for Payer: Aetna Commercial |
$4,018.64
|
| Rate for Payer: Cash Price |
$2,790.72
|
| Rate for Payer: Cigna All Commercial |
$4,013.99
|
| Rate for Payer: CORVEL All Commercial |
$4,325.62
|
| Rate for Payer: Coventry All Commercial |
$4,093.06
|
| Rate for Payer: Encore All Commercial |
$4,281.43
|
| Rate for Payer: Frontpath All Commercial |
$4,279.10
|
| Rate for Payer: Humana ChoiceCare |
$4,017.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,186.08
|
| Rate for Payer: PHCS All Commercial |
$3,488.40
|
| Rate for Payer: PHP All Commercial |
$3,527.47
|
| Rate for Payer: Sagamore Health Network All Products |
$3,590.73
|
| Rate for Payer: Signature Care EPO |
$3,860.50
|
| Rate for Payer: Signature Care PPO |
$4,093.06
|
| Rate for Payer: United Healthcare Commercial |
$3,665.15
|
|
|
HC AR PLATE DIST FIB 8 H L
|
Facility
|
OP
|
$5,072.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,717.33 |
| Rate for Payer: Aetna Commercial |
$4,281.11
|
| Rate for Payer: Aetna Medicare |
$1,623.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,572.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,913.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,170.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,866.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,785.48
|
| Rate for Payer: Cash Price |
$3,043.44
|
| Rate for Payer: Cash Price |
$3,043.44
|
| Rate for Payer: Centivo All Commercial |
$2,759.39
|
| Rate for Payer: Cigna All Commercial |
$4,377.48
|
| Rate for Payer: CORVEL All Commercial |
$4,717.33
|
| Rate for Payer: Coventry All Commercial |
$4,463.71
|
| Rate for Payer: Encore All Commercial |
$4,669.14
|
| Rate for Payer: Frontpath All Commercial |
$4,666.61
|
| Rate for Payer: Humana ChoiceCare |
$4,381.03
|
| Rate for Payer: Humana Medicare |
$1,623.17
|
| Rate for Payer: Lucent All Commercial |
$2,759.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,565.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,804.30
|
| Rate for Payer: PHP All Commercial |
$3,846.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,978.24
|
| Rate for Payer: Sagamore Health Network All Products |
$3,915.89
|
| Rate for Payer: Signature Care EPO |
$4,210.09
|
| Rate for Payer: Signature Care PPO |
$4,463.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,311.54
|
| Rate for Payer: United Healthcare Commercial |
$3,997.05
|
| Rate for Payer: United Healthcare Medicare |
$1,623.17
|
|
|
HC AR PLATE DIST FIB 8 H L
|
Facility
|
IP
|
$5,072.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,804.30 |
| Max. Negotiated Rate |
$4,717.33 |
| Rate for Payer: Aetna Commercial |
$4,382.55
|
| Rate for Payer: Cash Price |
$3,043.44
|
| Rate for Payer: Cigna All Commercial |
$4,377.48
|
| Rate for Payer: CORVEL All Commercial |
$4,717.33
|
| Rate for Payer: Coventry All Commercial |
$4,463.71
|
| Rate for Payer: Encore All Commercial |
$4,669.14
|
| Rate for Payer: Frontpath All Commercial |
$4,666.61
|
| Rate for Payer: Humana ChoiceCare |
$4,381.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,565.16
|
| Rate for Payer: PHCS All Commercial |
$3,804.30
|
| Rate for Payer: PHP All Commercial |
$3,846.91
|
| Rate for Payer: Sagamore Health Network All Products |
$3,915.89
|
| Rate for Payer: Signature Care EPO |
$4,210.09
|
| Rate for Payer: Signature Care PPO |
$4,463.71
|
| Rate for Payer: United Healthcare Commercial |
$3,997.05
|
|
|
HC AR PLATE DIST FIB 8H LOCK L
|
Facility
|
OP
|
$5,072.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,717.33 |
| Rate for Payer: Aetna Commercial |
$4,281.11
|
| Rate for Payer: Aetna Medicare |
$1,623.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,572.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,913.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,170.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,866.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,785.48
|
| Rate for Payer: Cash Price |
$3,043.44
|
| Rate for Payer: Cash Price |
$3,043.44
|
| Rate for Payer: Centivo All Commercial |
$2,759.39
|
| Rate for Payer: Cigna All Commercial |
$4,377.48
|
| Rate for Payer: CORVEL All Commercial |
$4,717.33
|
| Rate for Payer: Coventry All Commercial |
$4,463.71
|
| Rate for Payer: Encore All Commercial |
$4,669.14
|
| Rate for Payer: Frontpath All Commercial |
$4,666.61
|
| Rate for Payer: Humana ChoiceCare |
$4,381.03
|
| Rate for Payer: Humana Medicare |
$1,623.17
|
| Rate for Payer: Lucent All Commercial |
$2,759.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,565.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,804.30
|
| Rate for Payer: PHP All Commercial |
$3,846.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,978.24
|
| Rate for Payer: Sagamore Health Network All Products |
$3,915.89
|
| Rate for Payer: Signature Care EPO |
$4,210.09
|
| Rate for Payer: Signature Care PPO |
$4,463.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,311.54
|
| Rate for Payer: United Healthcare Commercial |
$3,997.05
|
| Rate for Payer: United Healthcare Medicare |
$1,623.17
|
|
|
HC AR PLATE DIST FIB 8H LOCK L
|
Facility
|
IP
|
$5,072.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,804.30 |
| Max. Negotiated Rate |
$4,717.33 |
| Rate for Payer: Aetna Commercial |
$4,382.55
|
| Rate for Payer: Cash Price |
$3,043.44
|
| Rate for Payer: Cigna All Commercial |
$4,377.48
|
| Rate for Payer: CORVEL All Commercial |
$4,717.33
|
| Rate for Payer: Coventry All Commercial |
$4,463.71
|
| Rate for Payer: Encore All Commercial |
$4,669.14
|
| Rate for Payer: Frontpath All Commercial |
$4,666.61
|
| Rate for Payer: Humana ChoiceCare |
$4,381.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,565.16
|
| Rate for Payer: PHCS All Commercial |
$3,804.30
|
| Rate for Payer: PHP All Commercial |
$3,846.91
|
| Rate for Payer: Sagamore Health Network All Products |
$3,915.89
|
| Rate for Payer: Signature Care EPO |
$4,210.09
|
| Rate for Payer: Signature Care PPO |
$4,463.71
|
| Rate for Payer: United Healthcare Commercial |
$3,997.05
|
|
|
HC AR PLATE TUB 12H LOCK
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,160.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
|
|
HC AR PLATE TUB 12H LOCK
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,110.00
|
| Rate for Payer: Aetna Medicare |
$800.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$775.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,435.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,562.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$920.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$880.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Centivo All Commercial |
$1,360.00
|
| Rate for Payer: Cigna All Commercial |
$2,157.50
|
| Rate for Payer: CORVEL All Commercial |
$2,325.00
|
| Rate for Payer: Coventry All Commercial |
$2,200.00
|
| Rate for Payer: Encore All Commercial |
$2,301.25
|
| Rate for Payer: Frontpath All Commercial |
$2,300.00
|
| Rate for Payer: Humana ChoiceCare |
$2,159.25
|
| Rate for Payer: Humana Medicare |
$800.00
|
| Rate for Payer: Lucent All Commercial |
$1,360.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,250.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: PHP All Commercial |
$1,896.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$975.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,930.00
|
| Rate for Payer: Signature Care EPO |
$2,075.00
|
| Rate for Payer: Signature Care PPO |
$2,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare Commercial |
$1,970.00
|
| Rate for Payer: United Healthcare Medicare |
$800.00
|
|
|
HC AR PLATE TUB 4H LOCK
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.25 |
| Max. Negotiated Rate |
$1,743.75 |
| Rate for Payer: Aetna Commercial |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna All Commercial |
$1,618.12
|
| Rate for Payer: CORVEL All Commercial |
$1,743.75
|
| Rate for Payer: Coventry All Commercial |
$1,650.00
|
| Rate for Payer: Encore All Commercial |
$1,725.94
|
| Rate for Payer: Frontpath All Commercial |
$1,725.00
|
| Rate for Payer: Humana ChoiceCare |
$1,619.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,687.50
|
| Rate for Payer: PHCS All Commercial |
$1,406.25
|
| Rate for Payer: PHP All Commercial |
$1,422.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,447.50
|
| Rate for Payer: Signature Care EPO |
$1,556.25
|
| Rate for Payer: Signature Care PPO |
$1,650.00
|
| Rate for Payer: United Healthcare Commercial |
$1,477.50
|
|
