|
HC AR SCREW LO PRO 4X38
|
Facility
|
OP
|
$907.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$843.98 |
| Rate for Payer: Aetna Commercial |
$765.93
|
| Rate for Payer: Aetna Medicare |
$290.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$281.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$521.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$567.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$319.44
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Centivo All Commercial |
$493.68
|
| Rate for Payer: Cigna All Commercial |
$783.17
|
| Rate for Payer: CORVEL All Commercial |
$843.98
|
| Rate for Payer: Coventry All Commercial |
$798.60
|
| Rate for Payer: Encore All Commercial |
$835.35
|
| Rate for Payer: Frontpath All Commercial |
$834.90
|
| Rate for Payer: Humana ChoiceCare |
$783.81
|
| Rate for Payer: Humana Medicare |
$290.40
|
| Rate for Payer: Lucent All Commercial |
$493.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$816.75
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$680.62
|
| Rate for Payer: PHP All Commercial |
$688.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$353.93
|
| Rate for Payer: Sagamore Health Network All Products |
$700.59
|
| Rate for Payer: Signature Care EPO |
$753.23
|
| Rate for Payer: Signature Care PPO |
$798.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$771.38
|
| Rate for Payer: United Healthcare Commercial |
$715.11
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
|
|
HC AR SCREW LO PRO 4X38
|
Facility
|
IP
|
$907.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$680.62 |
| Max. Negotiated Rate |
$843.98 |
| Rate for Payer: Aetna Commercial |
$784.08
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna All Commercial |
$783.17
|
| Rate for Payer: CORVEL All Commercial |
$843.98
|
| Rate for Payer: Coventry All Commercial |
$798.60
|
| Rate for Payer: Encore All Commercial |
$835.35
|
| Rate for Payer: Frontpath All Commercial |
$834.90
|
| Rate for Payer: Humana ChoiceCare |
$783.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$816.75
|
| Rate for Payer: PHCS All Commercial |
$680.62
|
| Rate for Payer: PHP All Commercial |
$688.25
|
| Rate for Payer: Sagamore Health Network All Products |
$700.59
|
| Rate for Payer: Signature Care EPO |
$753.23
|
| Rate for Payer: Signature Care PPO |
$798.60
|
| Rate for Payer: United Healthcare Commercial |
$715.11
|
|
|
HC AR SCREW VAL KRE 3X14
|
Facility
|
IP
|
$2,460.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.00 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,125.44
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
|
|
HC AR SCREW VAL KRE 3X14
|
Facility
|
OP
|
$2,460.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,076.24
|
| Rate for Payer: Aetna Medicare |
$787.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$762.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,412.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,537.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$905.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$865.92
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Centivo All Commercial |
$1,338.24
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Humana Medicare |
$787.20
|
| Rate for Payer: Lucent All Commercial |
$1,338.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$959.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,091.00
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
| Rate for Payer: United Healthcare Medicare |
$787.20
|
|
|
HC AR SCREW VAL KRE 3X20
|
Facility
|
IP
|
$2,460.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.00 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,125.44
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
|
|
HC AR SCREW VAL KRE 3X20
|
Facility
|
OP
|
$2,460.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,076.24
|
| Rate for Payer: Aetna Medicare |
$787.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$762.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,412.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,537.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$905.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$865.92
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Centivo All Commercial |
$1,338.24
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Humana Medicare |
$787.20
|
| Rate for Payer: Lucent All Commercial |
$1,338.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$959.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,091.00
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
| Rate for Payer: United Healthcare Medicare |
$787.20
|
|
|
HC ARSENIC
|
Facility
|
OP
|
$173.91
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
63001469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$146.78
|
| Rate for Payer: Aetna Medicare |
$55.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.22
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Centivo All Commercial |
$94.61
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$161.74
|
| Rate for Payer: Coventry All Commercial |
$153.04
|
| Rate for Payer: Encore All Commercial |
$160.08
|
| Rate for Payer: Frontpath All Commercial |
$160.00
|
| Rate for Payer: Humana ChoiceCare |
$150.21
|
| Rate for Payer: Humana Medicare |
$55.65
|
| Rate for Payer: Lucent All Commercial |
$94.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.52
|
| Rate for Payer: Managed Health Services Medicaid |
$18.97
|
| Rate for Payer: MDWise Medicaid |
$18.97
|
| Rate for Payer: PHCS All Commercial |
$130.43
|
| Rate for Payer: PHP All Commercial |
$131.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.82
|
| Rate for Payer: Sagamore Health Network All Products |
$134.26
|
| Rate for Payer: Signature Care EPO |
$144.35
|
| Rate for Payer: Signature Care PPO |
$153.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.82
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
| Rate for Payer: United Healthcare Medicare |
$55.65
|
|
|
HC ARSENIC
|
Facility
|
IP
|
$173.91
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
63001469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$150.26
|
| Rate for Payer: Cash Price |
$104.35
|
| Rate for Payer: Cigna All Commercial |
$150.08
|
| Rate for Payer: CORVEL All Commercial |
$161.74
|
| Rate for Payer: Coventry All Commercial |
$153.04
|
| Rate for Payer: Encore All Commercial |
$160.08
|
| Rate for Payer: Frontpath All Commercial |
$160.00
|
| Rate for Payer: Humana ChoiceCare |
$150.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$156.52
|
| Rate for Payer: PHCS All Commercial |
$130.43
|
| Rate for Payer: PHP All Commercial |
$131.89
|
| Rate for Payer: Sagamore Health Network All Products |
$134.26
|
| Rate for Payer: Signature Care EPO |
$144.35
|
| Rate for Payer: Signature Care PPO |
$153.04
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
|
|
HC AR SPEEDBRG IMP SWVLK W NDL
|
Facility
|
OP
|
$12,902.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$11,999.23 |
| Rate for Payer: Aetna Commercial |
$10,889.63
|
| Rate for Payer: Aetna Medicare |
$4,128.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,999.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,409.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8,065.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,748.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,541.64
|
| Rate for Payer: Cash Price |
$7,741.44
|
| Rate for Payer: Cash Price |
$7,741.44
|
| Rate for Payer: Centivo All Commercial |
$7,018.91
|
| Rate for Payer: Cigna All Commercial |
$11,134.77
|
| Rate for Payer: CORVEL All Commercial |
$11,999.23
|
| Rate for Payer: Coventry All Commercial |
$11,354.11
|
| Rate for Payer: Encore All Commercial |
$11,876.66
|
| Rate for Payer: Frontpath All Commercial |
$11,870.21
|
| Rate for Payer: Humana ChoiceCare |
$11,143.80
|
| Rate for Payer: Humana Medicare |
$4,128.77
|
| Rate for Payer: Lucent All Commercial |
$7,018.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,612.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$9,676.80
|
| Rate for Payer: PHP All Commercial |
$9,785.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,031.94
|
| Rate for Payer: Sagamore Health Network All Products |
$9,960.65
|
| Rate for Payer: Signature Care EPO |
$10,708.99
|
| Rate for Payer: Signature Care PPO |
$11,354.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,967.04
|
| Rate for Payer: United Healthcare Commercial |
$10,167.09
|
| Rate for Payer: United Healthcare Medicare |
$4,128.77
|
|
|
HC AR SPEEDBRG IMP SWVLK W NDL
|
Facility
|
IP
|
$12,902.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,676.80 |
| Max. Negotiated Rate |
$11,999.23 |
| Rate for Payer: Aetna Commercial |
$11,147.67
|
| Rate for Payer: Cash Price |
$7,741.44
|
| Rate for Payer: Cigna All Commercial |
$11,134.77
|
| Rate for Payer: CORVEL All Commercial |
$11,999.23
|
| Rate for Payer: Coventry All Commercial |
$11,354.11
|
| Rate for Payer: Encore All Commercial |
$11,876.66
|
| Rate for Payer: Frontpath All Commercial |
$11,870.21
|
| Rate for Payer: Humana ChoiceCare |
$11,143.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,612.16
|
| Rate for Payer: PHCS All Commercial |
$9,676.80
|
| Rate for Payer: PHP All Commercial |
$9,785.18
|
| Rate for Payer: Sagamore Health Network All Products |
$9,960.65
|
| Rate for Payer: Signature Care EPO |
$10,708.99
|
| Rate for Payer: Signature Care PPO |
$11,354.11
|
| Rate for Payer: United Healthcare Commercial |
$10,167.09
|
|
|
HC AR SPEEDBRIDGE ACHILLES 3.9
|
Facility
|
IP
|
$16,502.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,376.80 |
| Max. Negotiated Rate |
$15,347.23 |
| Rate for Payer: Aetna Commercial |
$14,258.07
|
| Rate for Payer: Cash Price |
$9,901.44
|
| Rate for Payer: Cigna All Commercial |
$14,241.57
|
| Rate for Payer: CORVEL All Commercial |
$15,347.23
|
| Rate for Payer: Coventry All Commercial |
$14,522.11
|
| Rate for Payer: Encore All Commercial |
$15,190.46
|
| Rate for Payer: Frontpath All Commercial |
$15,182.21
|
| Rate for Payer: Humana ChoiceCare |
$14,253.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,852.16
|
| Rate for Payer: PHCS All Commercial |
$12,376.80
|
| Rate for Payer: PHP All Commercial |
$12,515.42
|
| Rate for Payer: Sagamore Health Network All Products |
$12,739.85
|
| Rate for Payer: Signature Care EPO |
$13,696.99
|
| Rate for Payer: Signature Care PPO |
$14,522.11
|
| Rate for Payer: United Healthcare Commercial |
$13,003.89
|
|
|
HC AR SPEEDBRIDGE ACHILLES 3.9
|
Facility
|
OP
|
$16,502.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$15,347.23 |
| Rate for Payer: Aetna Commercial |
$13,928.03
|
| Rate for Payer: Aetna Medicare |
$5,280.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,115.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,477.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,315.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,072.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,808.84
|
| Rate for Payer: Cash Price |
$9,901.44
|
| Rate for Payer: Cash Price |
$9,901.44
|
| Rate for Payer: Centivo All Commercial |
$8,977.31
|
| Rate for Payer: Cigna All Commercial |
$14,241.57
|
| Rate for Payer: CORVEL All Commercial |
$15,347.23
|
| Rate for Payer: Coventry All Commercial |
$14,522.11
|
| Rate for Payer: Encore All Commercial |
$15,190.46
|
| Rate for Payer: Frontpath All Commercial |
$15,182.21
|
| Rate for Payer: Humana ChoiceCare |
$14,253.12
|
| Rate for Payer: Humana Medicare |
$5,280.77
|
| Rate for Payer: Lucent All Commercial |
$8,977.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,852.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$12,376.80
|
| Rate for Payer: PHP All Commercial |
$12,515.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,435.94
|
| Rate for Payer: Sagamore Health Network All Products |
$12,739.85
|
| Rate for Payer: Signature Care EPO |
$13,696.99
|
| Rate for Payer: Signature Care PPO |
$14,522.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,027.04
|
| Rate for Payer: United Healthcare Commercial |
$13,003.89
|
| Rate for Payer: United Healthcare Medicare |
$5,280.77
|
|
|
HC AR SPEED BRIDGE SWVL LOCK
|
Facility
|
OP
|
$6,336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,892.48 |
| Rate for Payer: Aetna Commercial |
$5,347.58
|
| Rate for Payer: Aetna Medicare |
$2,027.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,964.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,638.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,960.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,331.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,230.27
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Centivo All Commercial |
$3,446.78
|
| Rate for Payer: Cigna All Commercial |
$5,467.97
|
| Rate for Payer: CORVEL All Commercial |
$5,892.48
|
| Rate for Payer: Coventry All Commercial |
$5,575.68
|
| Rate for Payer: Encore All Commercial |
$5,832.29
|
| Rate for Payer: Frontpath All Commercial |
$5,829.12
|
| Rate for Payer: Humana ChoiceCare |
$5,472.40
|
| Rate for Payer: Humana Medicare |
$2,027.52
|
| Rate for Payer: Lucent All Commercial |
$3,446.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,702.40
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,752.00
|
| Rate for Payer: PHP All Commercial |
$4,805.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,471.04
|
| Rate for Payer: Sagamore Health Network All Products |
$4,891.39
|
| Rate for Payer: Signature Care EPO |
$5,258.88
|
| Rate for Payer: Signature Care PPO |
$5,575.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,385.60
|
| Rate for Payer: United Healthcare Commercial |
$4,992.77
|
| Rate for Payer: United Healthcare Medicare |
$2,027.52
|
|
|
HC AR SPEED BRIDGE SWVL LOCK
|
Facility
|
IP
|
$6,336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,752.00 |
| Max. Negotiated Rate |
$5,892.48 |
| Rate for Payer: Aetna Commercial |
$5,474.30
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cigna All Commercial |
$5,467.97
|
| Rate for Payer: CORVEL All Commercial |
$5,892.48
|
| Rate for Payer: Coventry All Commercial |
$5,575.68
|
| Rate for Payer: Encore All Commercial |
$5,832.29
|
| Rate for Payer: Frontpath All Commercial |
$5,829.12
|
| Rate for Payer: Humana ChoiceCare |
$5,472.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,702.40
|
| Rate for Payer: PHCS All Commercial |
$4,752.00
|
| Rate for Payer: PHP All Commercial |
$4,805.22
|
| Rate for Payer: Sagamore Health Network All Products |
$4,891.39
|
| Rate for Payer: Signature Care EPO |
$5,258.88
|
| Rate for Payer: Signature Care PPO |
$5,575.68
|
| Rate for Payer: United Healthcare Commercial |
$4,992.77
|
|
|
HC AR SUT ANCHOR 2.9X12.5
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Aetna Commercial |
$1,856.80
|
| Rate for Payer: Aetna Medicare |
$704.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$682.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,263.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,375.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$809.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$774.40
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Centivo All Commercial |
$1,196.80
|
| Rate for Payer: Cigna All Commercial |
$1,898.60
|
| Rate for Payer: CORVEL All Commercial |
$2,046.00
|
| Rate for Payer: Coventry All Commercial |
$1,936.00
|
| Rate for Payer: Encore All Commercial |
$2,025.10
|
| Rate for Payer: Frontpath All Commercial |
$2,024.00
|
| Rate for Payer: Humana ChoiceCare |
$1,900.14
|
| Rate for Payer: Humana Medicare |
$704.00
|
| Rate for Payer: Lucent All Commercial |
$1,196.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,650.00
|
| Rate for Payer: PHP All Commercial |
$1,668.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$858.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,698.40
|
| Rate for Payer: Signature Care EPO |
$1,826.00
|
| Rate for Payer: Signature Care PPO |
$1,936.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,733.60
|
| Rate for Payer: United Healthcare Medicare |
$704.00
|
|
|
HC AR SUT ANCHOR 2.9X12.5
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna All Commercial |
$1,898.60
|
| Rate for Payer: CORVEL All Commercial |
$2,046.00
|
| Rate for Payer: Coventry All Commercial |
$1,936.00
|
| Rate for Payer: Encore All Commercial |
$2,025.10
|
| Rate for Payer: Frontpath All Commercial |
$2,024.00
|
| Rate for Payer: Humana ChoiceCare |
$1,900.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: PHCS All Commercial |
$1,650.00
|
| Rate for Payer: PHP All Commercial |
$1,668.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,698.40
|
| Rate for Payer: Signature Care EPO |
$1,826.00
|
| Rate for Payer: Signature Care PPO |
$1,936.00
|
| Rate for Payer: United Healthcare Commercial |
$1,733.60
|
|
|
HC AR SUT ANCHOR 3X12.7
|
Facility
|
OP
|
$2,117.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,969.28 |
| Rate for Payer: Aetna Commercial |
$1,787.17
|
| Rate for Payer: Aetna Medicare |
$677.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$656.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,216.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,323.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$779.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$745.36
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Centivo All Commercial |
$1,151.92
|
| Rate for Payer: Cigna All Commercial |
$1,827.40
|
| Rate for Payer: CORVEL All Commercial |
$1,969.28
|
| Rate for Payer: Coventry All Commercial |
$1,863.40
|
| Rate for Payer: Encore All Commercial |
$1,949.16
|
| Rate for Payer: Frontpath All Commercial |
$1,948.10
|
| Rate for Payer: Humana ChoiceCare |
$1,828.88
|
| Rate for Payer: Humana Medicare |
$677.60
|
| Rate for Payer: Lucent All Commercial |
$1,151.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,905.75
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,588.12
|
| Rate for Payer: PHP All Commercial |
$1,605.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$825.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,634.71
|
| Rate for Payer: Signature Care EPO |
$1,757.53
|
| Rate for Payer: Signature Care PPO |
$1,863.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,799.88
|
| Rate for Payer: United Healthcare Commercial |
$1,668.59
|
| Rate for Payer: United Healthcare Medicare |
$677.60
|
|
|
HC AR SUT ANCHOR 3X12.7
|
Facility
|
IP
|
$2,117.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.12 |
| Max. Negotiated Rate |
$1,969.28 |
| Rate for Payer: Aetna Commercial |
$1,829.52
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Cigna All Commercial |
$1,827.40
|
| Rate for Payer: CORVEL All Commercial |
$1,969.28
|
| Rate for Payer: Coventry All Commercial |
$1,863.40
|
| Rate for Payer: Encore All Commercial |
$1,949.16
|
| Rate for Payer: Frontpath All Commercial |
$1,948.10
|
| Rate for Payer: Humana ChoiceCare |
$1,828.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,905.75
|
| Rate for Payer: PHCS All Commercial |
$1,588.12
|
| Rate for Payer: PHP All Commercial |
$1,605.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,634.71
|
| Rate for Payer: Signature Care EPO |
$1,757.53
|
| Rate for Payer: Signature Care PPO |
$1,863.40
|
| Rate for Payer: United Healthcare Commercial |
$1,668.59
|
|
|
HC AR SUT ANCHOR 4.75X19.1
|
Facility
|
OP
|
$2,062.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,918.12 |
| Rate for Payer: Aetna Commercial |
$1,740.75
|
| Rate for Payer: Aetna Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$639.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,184.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,289.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$759.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$726.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Centivo All Commercial |
$1,122.00
|
| Rate for Payer: Cigna All Commercial |
$1,779.94
|
| Rate for Payer: CORVEL All Commercial |
$1,918.12
|
| Rate for Payer: Coventry All Commercial |
$1,815.00
|
| Rate for Payer: Encore All Commercial |
$1,898.53
|
| Rate for Payer: Frontpath All Commercial |
$1,897.50
|
| Rate for Payer: Humana ChoiceCare |
$1,781.38
|
| Rate for Payer: Humana Medicare |
$660.00
|
| Rate for Payer: Lucent All Commercial |
$1,122.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,856.25
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,546.88
|
| Rate for Payer: PHP All Commercial |
$1,564.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$804.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,592.25
|
| Rate for Payer: Signature Care EPO |
$1,711.88
|
| Rate for Payer: Signature Care PPO |
$1,815.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,753.12
|
| Rate for Payer: United Healthcare Commercial |
$1,625.25
|
| Rate for Payer: United Healthcare Medicare |
$660.00
|
|
|
HC AR SUT ANCHOR 4.75X19.1
|
Facility
|
IP
|
$2,062.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,546.88 |
| Max. Negotiated Rate |
$1,918.12 |
| Rate for Payer: Aetna Commercial |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna All Commercial |
$1,779.94
|
| Rate for Payer: CORVEL All Commercial |
$1,918.12
|
| Rate for Payer: Coventry All Commercial |
$1,815.00
|
| Rate for Payer: Encore All Commercial |
$1,898.53
|
| Rate for Payer: Frontpath All Commercial |
$1,897.50
|
| Rate for Payer: Humana ChoiceCare |
$1,781.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,856.25
|
| Rate for Payer: PHCS All Commercial |
$1,546.88
|
| Rate for Payer: PHP All Commercial |
$1,564.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,592.25
|
| Rate for Payer: Signature Care EPO |
$1,711.88
|
| Rate for Payer: Signature Care PPO |
$1,815.00
|
| Rate for Payer: United Healthcare Commercial |
$1,625.25
|
|
|
HC AR SUT ANCHOR CORK 5.5X14.7
|
Facility
|
IP
|
$2,714.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,035.80 |
| Max. Negotiated Rate |
$2,524.39 |
| Rate for Payer: Aetna Commercial |
$2,345.24
|
| Rate for Payer: Cash Price |
$1,628.64
|
| Rate for Payer: Cigna All Commercial |
$2,342.53
|
| Rate for Payer: CORVEL All Commercial |
$2,524.39
|
| Rate for Payer: Coventry All Commercial |
$2,388.67
|
| Rate for Payer: Encore All Commercial |
$2,498.61
|
| Rate for Payer: Frontpath All Commercial |
$2,497.25
|
| Rate for Payer: Humana ChoiceCare |
$2,344.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,442.96
|
| Rate for Payer: PHCS All Commercial |
$2,035.80
|
| Rate for Payer: PHP All Commercial |
$2,058.60
|
| Rate for Payer: Sagamore Health Network All Products |
$2,095.52
|
| Rate for Payer: Signature Care EPO |
$2,252.95
|
| Rate for Payer: Signature Care PPO |
$2,388.67
|
| Rate for Payer: United Healthcare Commercial |
$2,138.95
|
|
|
HC AR SUT ANCHOR CORK 5.5X14.7
|
Facility
|
OP
|
$2,714.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,524.39 |
| Rate for Payer: Aetna Commercial |
$2,290.95
|
| Rate for Payer: Aetna Medicare |
$868.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$841.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,558.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,696.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$998.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$955.47
|
| Rate for Payer: Cash Price |
$1,628.64
|
| Rate for Payer: Cash Price |
$1,628.64
|
| Rate for Payer: Centivo All Commercial |
$1,476.63
|
| Rate for Payer: Cigna All Commercial |
$2,342.53
|
| Rate for Payer: CORVEL All Commercial |
$2,524.39
|
| Rate for Payer: Coventry All Commercial |
$2,388.67
|
| Rate for Payer: Encore All Commercial |
$2,498.61
|
| Rate for Payer: Frontpath All Commercial |
$2,497.25
|
| Rate for Payer: Humana ChoiceCare |
$2,344.43
|
| Rate for Payer: Humana Medicare |
$868.61
|
| Rate for Payer: Lucent All Commercial |
$1,476.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,442.96
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,035.80
|
| Rate for Payer: PHP All Commercial |
$2,058.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,058.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,095.52
|
| Rate for Payer: Signature Care EPO |
$2,252.95
|
| Rate for Payer: Signature Care PPO |
$2,388.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,307.24
|
| Rate for Payer: United Healthcare Commercial |
$2,138.95
|
| Rate for Payer: United Healthcare Medicare |
$868.61
|
|
|
HC AR SUT ANCHOR CORK VENT 5.5X14.7
|
Facility
|
IP
|
$1,951.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.40 |
| Max. Negotiated Rate |
$1,814.62 |
| Rate for Payer: Aetna Commercial |
$1,685.84
|
| Rate for Payer: Cash Price |
$1,170.72
|
| Rate for Payer: Cigna All Commercial |
$1,683.89
|
| Rate for Payer: CORVEL All Commercial |
$1,814.62
|
| Rate for Payer: Coventry All Commercial |
$1,717.06
|
| Rate for Payer: Encore All Commercial |
$1,796.08
|
| Rate for Payer: Frontpath All Commercial |
$1,795.10
|
| Rate for Payer: Humana ChoiceCare |
$1,685.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,756.08
|
| Rate for Payer: PHCS All Commercial |
$1,463.40
|
| Rate for Payer: PHP All Commercial |
$1,479.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,506.33
|
| Rate for Payer: Signature Care EPO |
$1,619.50
|
| Rate for Payer: Signature Care PPO |
$1,717.06
|
| Rate for Payer: United Healthcare Commercial |
$1,537.55
|
|
|
HC AR SUT ANCHOR CORK VENT 5.5X14.7
|
Facility
|
OP
|
$1,951.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,814.62 |
| Rate for Payer: Aetna Commercial |
$1,646.81
|
| Rate for Payer: Aetna Medicare |
$624.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$604.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,120.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,219.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$718.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.82
|
| Rate for Payer: Cash Price |
$1,170.72
|
| Rate for Payer: Cash Price |
$1,170.72
|
| Rate for Payer: Centivo All Commercial |
$1,061.45
|
| Rate for Payer: Cigna All Commercial |
$1,683.89
|
| Rate for Payer: CORVEL All Commercial |
$1,814.62
|
| Rate for Payer: Coventry All Commercial |
$1,717.06
|
| Rate for Payer: Encore All Commercial |
$1,796.08
|
| Rate for Payer: Frontpath All Commercial |
$1,795.10
|
| Rate for Payer: Humana ChoiceCare |
$1,685.25
|
| Rate for Payer: Humana Medicare |
$624.38
|
| Rate for Payer: Lucent All Commercial |
$1,061.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,756.08
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,463.40
|
| Rate for Payer: PHP All Commercial |
$1,479.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$760.97
|
| Rate for Payer: Sagamore Health Network All Products |
$1,506.33
|
| Rate for Payer: Signature Care EPO |
$1,619.50
|
| Rate for Payer: Signature Care PPO |
$1,717.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,658.52
|
| Rate for Payer: United Healthcare Commercial |
$1,537.55
|
| Rate for Payer: United Healthcare Medicare |
$624.38
|
|
|
HC AR SUT ANCHOR FIBERTAK 1.8
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,815.00 |
| Max. Negotiated Rate |
$2,250.60 |
| Rate for Payer: Aetna Commercial |
$2,090.88
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna All Commercial |
$2,088.46
|
| Rate for Payer: CORVEL All Commercial |
$2,250.60
|
| Rate for Payer: Coventry All Commercial |
$2,129.60
|
| Rate for Payer: Encore All Commercial |
$2,227.61
|
| Rate for Payer: Frontpath All Commercial |
$2,226.40
|
| Rate for Payer: Humana ChoiceCare |
$2,090.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,178.00
|
| Rate for Payer: PHCS All Commercial |
$1,815.00
|
| Rate for Payer: PHP All Commercial |
$1,835.33
|
| Rate for Payer: Sagamore Health Network All Products |
$1,868.24
|
| Rate for Payer: Signature Care EPO |
$2,008.60
|
| Rate for Payer: Signature Care PPO |
$2,129.60
|
| Rate for Payer: United Healthcare Commercial |
$1,906.96
|
|
