|
HC DS PLATE DR 2.4 VA 7H/3H L
|
Facility
|
OP
|
$6,485.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,031.76 |
| Rate for Payer: Aetna Commercial |
$5,473.98
|
| Rate for Payer: Aetna Medicare |
$2,075.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,010.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,724.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,054.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,386.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,282.99
|
| Rate for Payer: Cash Price |
$3,891.46
|
| Rate for Payer: Cash Price |
$3,891.46
|
| Rate for Payer: Centivo All Commercial |
$3,528.25
|
| Rate for Payer: Cigna All Commercial |
$5,597.21
|
| Rate for Payer: CORVEL All Commercial |
$6,031.76
|
| Rate for Payer: Coventry All Commercial |
$5,707.47
|
| Rate for Payer: Encore All Commercial |
$5,970.14
|
| Rate for Payer: Frontpath All Commercial |
$5,966.90
|
| Rate for Payer: Humana ChoiceCare |
$5,601.75
|
| Rate for Payer: Humana Medicare |
$2,075.44
|
| Rate for Payer: Lucent All Commercial |
$3,528.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,837.18
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,864.32
|
| Rate for Payer: PHP All Commercial |
$4,918.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,529.45
|
| Rate for Payer: Sagamore Health Network All Products |
$5,007.01
|
| Rate for Payer: Signature Care EPO |
$5,383.18
|
| Rate for Payer: Signature Care PPO |
$5,707.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,512.90
|
| Rate for Payer: United Healthcare Commercial |
$5,110.78
|
| Rate for Payer: United Healthcare Medicare |
$2,075.44
|
|
|
HC DS REV LINER 32+0 XLINK R
|
Facility
|
OP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,709.52
|
| Rate for Payer: Aetna Medicare |
$1,785.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,729.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,204.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,488.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,053.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,964.16
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Humana Medicare |
$1,785.60
|
| Rate for Payer: Lucent All Commercial |
$3,035.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,176.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,743.00
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
| Rate for Payer: United Healthcare Medicare |
$1,785.60
|
|
|
HC DS REV LINER 32+0 XLINK R
|
Facility
|
IP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,185.00 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,821.12
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
|
|
HC DS REV LINER 36+0 XLINK
|
Facility
|
OP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,709.52
|
| Rate for Payer: Aetna Medicare |
$1,785.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,729.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,204.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,488.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,053.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,964.16
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Humana Medicare |
$1,785.60
|
| Rate for Payer: Lucent All Commercial |
$3,035.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,176.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,743.00
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
| Rate for Payer: United Healthcare Medicare |
$1,785.60
|
|
|
HC DS REV LINER 36+0 XLINK
|
Facility
|
IP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,185.00 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,821.12
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
|
|
HC DS REV LINER 36+0 XLINK R 100
|
Facility
|
IP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,185.00 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,821.12
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
|
|
HC DS REV LINER 36+0 XLINK R 100
|
Facility
|
OP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,709.52
|
| Rate for Payer: Aetna Medicare |
$1,785.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,729.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,204.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,488.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,053.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,964.16
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Humana Medicare |
$1,785.60
|
| Rate for Payer: Lucent All Commercial |
$3,035.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,176.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,743.00
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
| Rate for Payer: United Healthcare Medicare |
$1,785.60
|
|
|
HC DS REV LINER 36+4 XLINK
|
Facility
|
OP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,709.52
|
| Rate for Payer: Aetna Medicare |
$1,785.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,729.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,204.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,488.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,053.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,964.16
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Humana Medicare |
$1,785.60
|
| Rate for Payer: Lucent All Commercial |
$3,035.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,176.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,743.00
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
| Rate for Payer: United Healthcare Medicare |
$1,785.60
|
|
|
HC DS REV LINER 36+4 XLINK
|
Facility
|
IP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,185.00 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,821.12
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
|
|
HC DS REV LINER X-LINK 32+0MM
|
Facility
|
OP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,709.52
|
| Rate for Payer: Aetna Medicare |
$1,785.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,729.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,204.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,488.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,053.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,964.16
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Centivo All Commercial |
$3,035.52
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Humana Medicare |
$1,785.60
|
| Rate for Payer: Lucent All Commercial |
$3,035.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,176.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,743.00
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
| Rate for Payer: United Healthcare Medicare |
$1,785.60
|
|
|
HC DS REV LINER X-LINK 32+0MM
|
Facility
|
IP
|
$5,580.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,185.00 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Aetna Commercial |
$4,821.12
|
| Rate for Payer: Cash Price |
$3,348.00
|
| Rate for Payer: Cigna All Commercial |
$4,815.54
|
| Rate for Payer: CORVEL All Commercial |
$5,189.40
|
| Rate for Payer: Coventry All Commercial |
$4,910.40
|
| Rate for Payer: Encore All Commercial |
$5,136.39
|
| Rate for Payer: Frontpath All Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$4,819.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,022.00
|
| Rate for Payer: PHCS All Commercial |
$4,185.00
|
| Rate for Payer: PHP All Commercial |
$4,231.87
|
| Rate for Payer: Sagamore Health Network All Products |
$4,307.76
|
| Rate for Payer: Signature Care EPO |
$4,631.40
|
| Rate for Payer: Signature Care PPO |
$4,910.40
|
| Rate for Payer: United Healthcare Commercial |
$4,397.04
|
|
|
HC DS REVS HUM SHELL 32+8 SM
|
Facility
|
OP
|
$10,080.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,374.40 |
| Rate for Payer: Aetna Commercial |
$8,507.52
|
| Rate for Payer: Aetna Medicare |
$3,225.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,124.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,788.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,301.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,709.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,548.16
|
| Rate for Payer: Cash Price |
$6,048.00
|
| Rate for Payer: Cash Price |
$6,048.00
|
| Rate for Payer: Centivo All Commercial |
$5,483.52
|
| Rate for Payer: Cigna All Commercial |
$8,699.04
|
| Rate for Payer: CORVEL All Commercial |
$9,374.40
|
| Rate for Payer: Coventry All Commercial |
$8,870.40
|
| Rate for Payer: Encore All Commercial |
$9,278.64
|
| Rate for Payer: Frontpath All Commercial |
$9,273.60
|
| Rate for Payer: Humana ChoiceCare |
$8,706.10
|
| Rate for Payer: Humana Medicare |
$3,225.60
|
| Rate for Payer: Lucent All Commercial |
$5,483.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,072.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,560.00
|
| Rate for Payer: PHP All Commercial |
$7,644.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,931.20
|
| Rate for Payer: Sagamore Health Network All Products |
$7,781.76
|
| Rate for Payer: Signature Care EPO |
$8,366.40
|
| Rate for Payer: Signature Care PPO |
$8,870.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,568.00
|
| Rate for Payer: United Healthcare Commercial |
$7,943.04
|
| Rate for Payer: United Healthcare Medicare |
$3,225.60
|
|
|
HC DS REVS HUM SHELL 32+8 SM
|
Facility
|
IP
|
$10,080.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,560.00 |
| Max. Negotiated Rate |
$9,374.40 |
| Rate for Payer: Aetna Commercial |
$8,709.12
|
| Rate for Payer: Cash Price |
$6,048.00
|
| Rate for Payer: Cigna All Commercial |
$8,699.04
|
| Rate for Payer: CORVEL All Commercial |
$9,374.40
|
| Rate for Payer: Coventry All Commercial |
$8,870.40
|
| Rate for Payer: Encore All Commercial |
$9,278.64
|
| Rate for Payer: Frontpath All Commercial |
$9,273.60
|
| Rate for Payer: Humana ChoiceCare |
$8,706.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,072.00
|
| Rate for Payer: PHCS All Commercial |
$7,560.00
|
| Rate for Payer: PHP All Commercial |
$7,644.67
|
| Rate for Payer: Sagamore Health Network All Products |
$7,781.76
|
| Rate for Payer: Signature Care EPO |
$8,366.40
|
| Rate for Payer: Signature Care PPO |
$8,870.40
|
| Rate for Payer: United Healthcare Commercial |
$7,943.04
|
|
|
HC DS REVS HUM SHELL 36+0 SM
|
Facility
|
OP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,469.12
|
| Rate for Payer: Aetna Medicare |
$2,073.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,721.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,050.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,384.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,280.96
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Centivo All Commercial |
$3,525.12
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Humana Medicare |
$2,073.60
|
| Rate for Payer: Lucent All Commercial |
$3,525.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,527.20
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,508.00
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare Medicare |
$2,073.60
|
|
|
HC DS REVS HUM SHELL 36+0 SM
|
Facility
|
IP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,598.72
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
|
|
HC DS REVS HUM SHELL 36+8 MD
|
Facility
|
OP
|
$10,080.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$9,374.40 |
| Rate for Payer: Aetna Commercial |
$8,507.52
|
| Rate for Payer: Aetna Medicare |
$3,225.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,124.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5,788.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,301.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,709.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,548.16
|
| Rate for Payer: Cash Price |
$6,048.00
|
| Rate for Payer: Cash Price |
$6,048.00
|
| Rate for Payer: Centivo All Commercial |
$5,483.52
|
| Rate for Payer: Cigna All Commercial |
$8,699.04
|
| Rate for Payer: CORVEL All Commercial |
$9,374.40
|
| Rate for Payer: Coventry All Commercial |
$8,870.40
|
| Rate for Payer: Encore All Commercial |
$9,278.64
|
| Rate for Payer: Frontpath All Commercial |
$9,273.60
|
| Rate for Payer: Humana ChoiceCare |
$8,706.10
|
| Rate for Payer: Humana Medicare |
$3,225.60
|
| Rate for Payer: Lucent All Commercial |
$5,483.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,072.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$7,560.00
|
| Rate for Payer: PHP All Commercial |
$7,644.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,931.20
|
| Rate for Payer: Sagamore Health Network All Products |
$7,781.76
|
| Rate for Payer: Signature Care EPO |
$8,366.40
|
| Rate for Payer: Signature Care PPO |
$8,870.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,568.00
|
| Rate for Payer: United Healthcare Commercial |
$7,943.04
|
| Rate for Payer: United Healthcare Medicare |
$3,225.60
|
|
|
HC DS REVS HUM SHELL 36+8 MD
|
Facility
|
IP
|
$10,080.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,560.00 |
| Max. Negotiated Rate |
$9,374.40 |
| Rate for Payer: Aetna Commercial |
$8,709.12
|
| Rate for Payer: Cash Price |
$6,048.00
|
| Rate for Payer: Cigna All Commercial |
$8,699.04
|
| Rate for Payer: CORVEL All Commercial |
$9,374.40
|
| Rate for Payer: Coventry All Commercial |
$8,870.40
|
| Rate for Payer: Encore All Commercial |
$9,278.64
|
| Rate for Payer: Frontpath All Commercial |
$9,273.60
|
| Rate for Payer: Humana ChoiceCare |
$8,706.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,072.00
|
| Rate for Payer: PHCS All Commercial |
$7,560.00
|
| Rate for Payer: PHP All Commercial |
$7,644.67
|
| Rate for Payer: Sagamore Health Network All Products |
$7,781.76
|
| Rate for Payer: Signature Care EPO |
$8,366.40
|
| Rate for Payer: Signature Care PPO |
$8,870.40
|
| Rate for Payer: United Healthcare Commercial |
$7,943.04
|
|
|
HC DS RVS HUM SHELL 32+0MM SM
|
Facility
|
OP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,469.12
|
| Rate for Payer: Aetna Medicare |
$2,073.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,008.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,721.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,050.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,384.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,280.96
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Centivo All Commercial |
$3,525.12
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Humana Medicare |
$2,073.60
|
| Rate for Payer: Lucent All Commercial |
$3,525.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,527.20
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,508.00
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare Medicare |
$2,073.60
|
|
|
HC DS RVS HUM SHELL 32+0MM SM
|
Facility
|
IP
|
$6,480.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41608403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,598.72
|
| Rate for Payer: Cash Price |
$3,888.00
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
|
|
HC DS SCREW 20 LOCK
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
|
|
HC DS SCREW 20 LOCK
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$886.20
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$603.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$656.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$369.60
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Centivo All Commercial |
$571.20
|
| Rate for Payer: Cigna All Commercial |
$906.15
|
| Rate for Payer: CORVEL All Commercial |
$976.50
|
| Rate for Payer: Coventry All Commercial |
$924.00
|
| Rate for Payer: Encore All Commercial |
$966.52
|
| Rate for Payer: Frontpath All Commercial |
$966.00
|
| Rate for Payer: Humana ChoiceCare |
$906.88
|
| Rate for Payer: Humana Medicare |
$336.00
|
| Rate for Payer: Lucent All Commercial |
$571.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$945.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$787.50
|
| Rate for Payer: PHP All Commercial |
$796.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$409.50
|
| Rate for Payer: Sagamore Health Network All Products |
$810.60
|
| Rate for Payer: Signature Care EPO |
$871.50
|
| Rate for Payer: Signature Care PPO |
$924.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$827.40
|
| Rate for Payer: United Healthcare Medicare |
$336.00
|
|
|
HC DS SCREW 2.4X14 CRTX ST
|
Facility
|
OP
|
$1,024.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$953.06 |
| Rate for Payer: Aetna Commercial |
$864.93
|
| Rate for Payer: Aetna Medicare |
$327.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$588.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$640.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$377.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.73
|
| Rate for Payer: Cash Price |
$614.88
|
| Rate for Payer: Cash Price |
$614.88
|
| Rate for Payer: Centivo All Commercial |
$557.49
|
| Rate for Payer: Cigna All Commercial |
$884.40
|
| Rate for Payer: CORVEL All Commercial |
$953.06
|
| Rate for Payer: Coventry All Commercial |
$901.82
|
| Rate for Payer: Encore All Commercial |
$943.33
|
| Rate for Payer: Frontpath All Commercial |
$942.82
|
| Rate for Payer: Humana ChoiceCare |
$885.12
|
| Rate for Payer: Humana Medicare |
$327.94
|
| Rate for Payer: Lucent All Commercial |
$557.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.32
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$768.60
|
| Rate for Payer: PHP All Commercial |
$777.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.67
|
| Rate for Payer: Sagamore Health Network All Products |
$791.15
|
| Rate for Payer: Signature Care EPO |
$850.58
|
| Rate for Payer: Signature Care PPO |
$901.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.08
|
| Rate for Payer: United Healthcare Commercial |
$807.54
|
| Rate for Payer: United Healthcare Medicare |
$327.94
|
|
|
HC DS SCREW 2.4X14 CRTX ST
|
Facility
|
IP
|
$1,024.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.60 |
| Max. Negotiated Rate |
$953.06 |
| Rate for Payer: Aetna Commercial |
$885.43
|
| Rate for Payer: Cash Price |
$614.88
|
| Rate for Payer: Cigna All Commercial |
$884.40
|
| Rate for Payer: CORVEL All Commercial |
$953.06
|
| Rate for Payer: Coventry All Commercial |
$901.82
|
| Rate for Payer: Encore All Commercial |
$943.33
|
| Rate for Payer: Frontpath All Commercial |
$942.82
|
| Rate for Payer: Humana ChoiceCare |
$885.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$922.32
|
| Rate for Payer: PHCS All Commercial |
$768.60
|
| Rate for Payer: PHP All Commercial |
$777.21
|
| Rate for Payer: Sagamore Health Network All Products |
$791.15
|
| Rate for Payer: Signature Care EPO |
$850.58
|
| Rate for Payer: Signature Care PPO |
$901.82
|
| Rate for Payer: United Healthcare Commercial |
$807.54
|
|
|
HC DS SCREW 2.4 X16 CRTX ST
|
Facility
|
IP
|
$574.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.92 |
| Max. Negotiated Rate |
$534.34 |
| Rate for Payer: Aetna Commercial |
$496.42
|
| Rate for Payer: Cash Price |
$344.74
|
| Rate for Payer: Cigna All Commercial |
$495.85
|
| Rate for Payer: CORVEL All Commercial |
$534.34
|
| Rate for Payer: Coventry All Commercial |
$505.61
|
| Rate for Payer: Encore All Commercial |
$528.88
|
| Rate for Payer: Frontpath All Commercial |
$528.60
|
| Rate for Payer: Humana ChoiceCare |
$496.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.10
|
| Rate for Payer: PHCS All Commercial |
$430.92
|
| Rate for Payer: PHP All Commercial |
$435.75
|
| Rate for Payer: Sagamore Health Network All Products |
$443.56
|
| Rate for Payer: Signature Care EPO |
$476.88
|
| Rate for Payer: Signature Care PPO |
$505.61
|
| Rate for Payer: United Healthcare Commercial |
$452.75
|
|
|
HC DS SCREW 2.4 X16 CRTX ST
|
Facility
|
OP
|
$574.56
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$534.34 |
| Rate for Payer: Aetna Commercial |
$484.93
|
| Rate for Payer: Aetna Medicare |
$183.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$178.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$329.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$359.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$211.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$202.25
|
| Rate for Payer: Cash Price |
$344.74
|
| Rate for Payer: Cash Price |
$344.74
|
| Rate for Payer: Centivo All Commercial |
$312.56
|
| Rate for Payer: Cigna All Commercial |
$495.85
|
| Rate for Payer: CORVEL All Commercial |
$534.34
|
| Rate for Payer: Coventry All Commercial |
$505.61
|
| Rate for Payer: Encore All Commercial |
$528.88
|
| Rate for Payer: Frontpath All Commercial |
$528.60
|
| Rate for Payer: Humana ChoiceCare |
$496.25
|
| Rate for Payer: Humana Medicare |
$183.86
|
| Rate for Payer: Lucent All Commercial |
$312.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.10
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$430.92
|
| Rate for Payer: PHP All Commercial |
$435.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$224.08
|
| Rate for Payer: Sagamore Health Network All Products |
$443.56
|
| Rate for Payer: Signature Care EPO |
$476.88
|
| Rate for Payer: Signature Care PPO |
$505.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$488.38
|
| Rate for Payer: United Healthcare Commercial |
$452.75
|
| Rate for Payer: United Healthcare Medicare |
$183.86
|
|
