|
HC Z PLATE FIB 7H LOCK
|
Facility
|
OP
|
$1,263.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,175.33 |
| Rate for Payer: Aetna Commercial |
$1,066.65
|
| Rate for Payer: Aetna Medicare |
$404.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$391.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$725.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$790.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$465.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$444.86
|
| Rate for Payer: Cash Price |
$758.28
|
| Rate for Payer: Cash Price |
$758.28
|
| Rate for Payer: Centivo All Commercial |
$687.51
|
| Rate for Payer: Cigna All Commercial |
$1,090.66
|
| Rate for Payer: CORVEL All Commercial |
$1,175.33
|
| Rate for Payer: Coventry All Commercial |
$1,112.14
|
| Rate for Payer: Encore All Commercial |
$1,163.33
|
| Rate for Payer: Frontpath All Commercial |
$1,162.70
|
| Rate for Payer: Humana ChoiceCare |
$1,091.54
|
| Rate for Payer: Humana Medicare |
$404.42
|
| Rate for Payer: Lucent All Commercial |
$687.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,137.42
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$947.85
|
| Rate for Payer: PHP All Commercial |
$958.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$492.88
|
| Rate for Payer: Sagamore Health Network All Products |
$975.65
|
| Rate for Payer: Signature Care EPO |
$1,048.95
|
| Rate for Payer: Signature Care PPO |
$1,112.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,074.23
|
| Rate for Payer: United Healthcare Commercial |
$995.87
|
| Rate for Payer: United Healthcare Medicare |
$404.42
|
|
|
HC Z PLATE FIB 8H COMP
|
Facility
|
OP
|
$2,988.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,778.84 |
| Rate for Payer: Aetna Commercial |
$2,521.87
|
| Rate for Payer: Aetna Medicare |
$956.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$926.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,716.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,867.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,099.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,051.78
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Centivo All Commercial |
$1,625.47
|
| Rate for Payer: Cigna All Commercial |
$2,578.64
|
| Rate for Payer: CORVEL All Commercial |
$2,778.84
|
| Rate for Payer: Coventry All Commercial |
$2,629.44
|
| Rate for Payer: Encore All Commercial |
$2,750.45
|
| Rate for Payer: Frontpath All Commercial |
$2,748.96
|
| Rate for Payer: Humana ChoiceCare |
$2,580.74
|
| Rate for Payer: Humana Medicare |
$956.16
|
| Rate for Payer: Lucent All Commercial |
$1,625.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,689.20
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,241.00
|
| Rate for Payer: PHP All Commercial |
$2,266.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,165.32
|
| Rate for Payer: Sagamore Health Network All Products |
$2,306.74
|
| Rate for Payer: Signature Care EPO |
$2,480.04
|
| Rate for Payer: Signature Care PPO |
$2,629.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,539.80
|
| Rate for Payer: United Healthcare Commercial |
$2,354.54
|
| Rate for Payer: United Healthcare Medicare |
$956.16
|
|
|
HC Z PLATE FIB 8H COMP
|
Facility
|
IP
|
$2,988.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,241.00 |
| Max. Negotiated Rate |
$2,778.84 |
| Rate for Payer: Aetna Commercial |
$2,581.63
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cigna All Commercial |
$2,578.64
|
| Rate for Payer: CORVEL All Commercial |
$2,778.84
|
| Rate for Payer: Coventry All Commercial |
$2,629.44
|
| Rate for Payer: Encore All Commercial |
$2,750.45
|
| Rate for Payer: Frontpath All Commercial |
$2,748.96
|
| Rate for Payer: Humana ChoiceCare |
$2,580.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,689.20
|
| Rate for Payer: PHCS All Commercial |
$2,241.00
|
| Rate for Payer: PHP All Commercial |
$2,266.10
|
| Rate for Payer: Sagamore Health Network All Products |
$2,306.74
|
| Rate for Payer: Signature Care EPO |
$2,480.04
|
| Rate for Payer: Signature Care PPO |
$2,629.44
|
| Rate for Payer: United Healthcare Commercial |
$2,354.54
|
|
|
HC Z PLATE FIB 8H LOCK
|
Facility
|
OP
|
$1,293.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,202.68 |
| Rate for Payer: Aetna Commercial |
$1,091.46
|
| Rate for Payer: Aetna Medicare |
$413.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$400.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$742.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$808.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$475.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.21
|
| Rate for Payer: Cash Price |
$775.92
|
| Rate for Payer: Cash Price |
$775.92
|
| Rate for Payer: Centivo All Commercial |
$703.50
|
| Rate for Payer: Cigna All Commercial |
$1,116.03
|
| Rate for Payer: CORVEL All Commercial |
$1,202.68
|
| Rate for Payer: Coventry All Commercial |
$1,138.02
|
| Rate for Payer: Encore All Commercial |
$1,190.39
|
| Rate for Payer: Frontpath All Commercial |
$1,189.74
|
| Rate for Payer: Humana ChoiceCare |
$1,116.94
|
| Rate for Payer: Humana Medicare |
$413.82
|
| Rate for Payer: Lucent All Commercial |
$703.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,163.88
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$969.90
|
| Rate for Payer: PHP All Commercial |
$980.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$504.35
|
| Rate for Payer: Sagamore Health Network All Products |
$998.35
|
| Rate for Payer: Signature Care EPO |
$1,073.36
|
| Rate for Payer: Signature Care PPO |
$1,138.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,099.22
|
| Rate for Payer: United Healthcare Commercial |
$1,019.04
|
| Rate for Payer: United Healthcare Medicare |
$413.82
|
|
|
HC Z PLATE FIB 8H LOCK
|
Facility
|
IP
|
$1,293.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.90 |
| Max. Negotiated Rate |
$1,202.68 |
| Rate for Payer: Aetna Commercial |
$1,117.32
|
| Rate for Payer: Cash Price |
$775.92
|
| Rate for Payer: Cigna All Commercial |
$1,116.03
|
| Rate for Payer: CORVEL All Commercial |
$1,202.68
|
| Rate for Payer: Coventry All Commercial |
$1,138.02
|
| Rate for Payer: Encore All Commercial |
$1,190.39
|
| Rate for Payer: Frontpath All Commercial |
$1,189.74
|
| Rate for Payer: Humana ChoiceCare |
$1,116.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,163.88
|
| Rate for Payer: PHCS All Commercial |
$969.90
|
| Rate for Payer: PHP All Commercial |
$980.76
|
| Rate for Payer: Sagamore Health Network All Products |
$998.35
|
| Rate for Payer: Signature Care EPO |
$1,073.36
|
| Rate for Payer: Signature Care PPO |
$1,138.02
|
| Rate for Payer: United Healthcare Commercial |
$1,019.04
|
|
|
HC Z PLATE FIB ANTMC 3-H L LOCK
|
Facility
|
IP
|
$2,461.79
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,846.34 |
| Max. Negotiated Rate |
$2,289.46 |
| Rate for Payer: Aetna Commercial |
$2,126.99
|
| Rate for Payer: Cash Price |
$1,477.07
|
| Rate for Payer: Cigna All Commercial |
$2,124.52
|
| Rate for Payer: CORVEL All Commercial |
$2,289.46
|
| Rate for Payer: Coventry All Commercial |
$2,166.38
|
| Rate for Payer: Encore All Commercial |
$2,266.08
|
| Rate for Payer: Frontpath All Commercial |
$2,264.85
|
| Rate for Payer: Humana ChoiceCare |
$2,126.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,215.61
|
| Rate for Payer: PHCS All Commercial |
$1,846.34
|
| Rate for Payer: PHP All Commercial |
$1,867.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,900.50
|
| Rate for Payer: Signature Care EPO |
$2,043.29
|
| Rate for Payer: Signature Care PPO |
$2,166.38
|
| Rate for Payer: United Healthcare Commercial |
$1,939.89
|
|
|
HC Z PLATE FIB ANTMC 3-H L LOCK
|
Facility
|
OP
|
$2,461.79
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,289.46 |
| Rate for Payer: Aetna Commercial |
$2,077.75
|
| Rate for Payer: Aetna Medicare |
$787.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$763.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,413.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,538.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$905.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$866.55
|
| Rate for Payer: Cash Price |
$1,477.07
|
| Rate for Payer: Cash Price |
$1,477.07
|
| Rate for Payer: Centivo All Commercial |
$1,339.21
|
| Rate for Payer: Cigna All Commercial |
$2,124.52
|
| Rate for Payer: CORVEL All Commercial |
$2,289.46
|
| Rate for Payer: Coventry All Commercial |
$2,166.38
|
| Rate for Payer: Encore All Commercial |
$2,266.08
|
| Rate for Payer: Frontpath All Commercial |
$2,264.85
|
| Rate for Payer: Humana ChoiceCare |
$2,126.25
|
| Rate for Payer: Humana Medicare |
$787.77
|
| Rate for Payer: Lucent All Commercial |
$1,339.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,215.61
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,846.34
|
| Rate for Payer: PHP All Commercial |
$1,867.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$960.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,900.50
|
| Rate for Payer: Signature Care EPO |
$2,043.29
|
| Rate for Payer: Signature Care PPO |
$2,166.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,092.52
|
| Rate for Payer: United Healthcare Commercial |
$1,939.89
|
| Rate for Payer: United Healthcare Medicare |
$787.77
|
|
|
HC Z PLATE FIB ANTMC 3-H LOCK R
|
Facility
|
OP
|
$2,461.79
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,289.46 |
| Rate for Payer: Aetna Commercial |
$2,077.75
|
| Rate for Payer: Aetna Medicare |
$787.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$763.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,413.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,538.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$905.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$866.55
|
| Rate for Payer: Cash Price |
$1,477.07
|
| Rate for Payer: Cash Price |
$1,477.07
|
| Rate for Payer: Centivo All Commercial |
$1,339.21
|
| Rate for Payer: Cigna All Commercial |
$2,124.52
|
| Rate for Payer: CORVEL All Commercial |
$2,289.46
|
| Rate for Payer: Coventry All Commercial |
$2,166.38
|
| Rate for Payer: Encore All Commercial |
$2,266.08
|
| Rate for Payer: Frontpath All Commercial |
$2,264.85
|
| Rate for Payer: Humana ChoiceCare |
$2,126.25
|
| Rate for Payer: Humana Medicare |
$787.77
|
| Rate for Payer: Lucent All Commercial |
$1,339.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,215.61
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,846.34
|
| Rate for Payer: PHP All Commercial |
$1,867.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$960.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,900.50
|
| Rate for Payer: Signature Care EPO |
$2,043.29
|
| Rate for Payer: Signature Care PPO |
$2,166.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,092.52
|
| Rate for Payer: United Healthcare Commercial |
$1,939.89
|
| Rate for Payer: United Healthcare Medicare |
$787.77
|
|
|
HC Z PLATE FIB ANTMC 3-H LOCK R
|
Facility
|
IP
|
$2,461.79
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,846.34 |
| Max. Negotiated Rate |
$2,289.46 |
| Rate for Payer: Aetna Commercial |
$2,126.99
|
| Rate for Payer: Cash Price |
$1,477.07
|
| Rate for Payer: Cigna All Commercial |
$2,124.52
|
| Rate for Payer: CORVEL All Commercial |
$2,289.46
|
| Rate for Payer: Coventry All Commercial |
$2,166.38
|
| Rate for Payer: Encore All Commercial |
$2,266.08
|
| Rate for Payer: Frontpath All Commercial |
$2,264.85
|
| Rate for Payer: Humana ChoiceCare |
$2,126.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,215.61
|
| Rate for Payer: PHCS All Commercial |
$1,846.34
|
| Rate for Payer: PHP All Commercial |
$1,867.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,900.50
|
| Rate for Payer: Signature Care EPO |
$2,043.29
|
| Rate for Payer: Signature Care PPO |
$2,166.38
|
| Rate for Payer: United Healthcare Commercial |
$1,939.89
|
|
|
HC Z PLATE LOCK NRW 4.5 10-H
|
Facility
|
IP
|
$1,444.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.22 |
| Max. Negotiated Rate |
$1,343.20 |
| Rate for Payer: Aetna Commercial |
$1,247.88
|
| Rate for Payer: Cash Price |
$866.58
|
| Rate for Payer: Cigna All Commercial |
$1,246.43
|
| Rate for Payer: CORVEL All Commercial |
$1,343.20
|
| Rate for Payer: Coventry All Commercial |
$1,270.98
|
| Rate for Payer: Encore All Commercial |
$1,329.48
|
| Rate for Payer: Frontpath All Commercial |
$1,328.76
|
| Rate for Payer: Humana ChoiceCare |
$1,247.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,299.87
|
| Rate for Payer: PHCS All Commercial |
$1,083.22
|
| Rate for Payer: PHP All Commercial |
$1,095.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,115.00
|
| Rate for Payer: Signature Care EPO |
$1,198.77
|
| Rate for Payer: Signature Care PPO |
$1,270.98
|
| Rate for Payer: United Healthcare Commercial |
$1,138.11
|
|
|
HC Z PLATE LOCK NRW 4.5 10-H
|
Facility
|
OP
|
$1,444.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,343.20 |
| Rate for Payer: Aetna Commercial |
$1,218.99
|
| Rate for Payer: Aetna Medicare |
$462.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$447.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$829.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$902.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$531.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$508.39
|
| Rate for Payer: Cash Price |
$866.58
|
| Rate for Payer: Cash Price |
$866.58
|
| Rate for Payer: Centivo All Commercial |
$785.70
|
| Rate for Payer: Cigna All Commercial |
$1,246.43
|
| Rate for Payer: CORVEL All Commercial |
$1,343.20
|
| Rate for Payer: Coventry All Commercial |
$1,270.98
|
| Rate for Payer: Encore All Commercial |
$1,329.48
|
| Rate for Payer: Frontpath All Commercial |
$1,328.76
|
| Rate for Payer: Humana ChoiceCare |
$1,247.44
|
| Rate for Payer: Humana Medicare |
$462.18
|
| Rate for Payer: Lucent All Commercial |
$785.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,299.87
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,083.22
|
| Rate for Payer: PHP All Commercial |
$1,095.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$563.28
|
| Rate for Payer: Sagamore Health Network All Products |
$1,115.00
|
| Rate for Payer: Signature Care EPO |
$1,198.77
|
| Rate for Payer: Signature Care PPO |
$1,270.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,227.65
|
| Rate for Payer: United Healthcare Commercial |
$1,138.11
|
| Rate for Payer: United Healthcare Medicare |
$462.18
|
|
|
HC Z PLATE LONG LOCK L
|
Facility
|
IP
|
$3,577.82
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,683.36 |
| Max. Negotiated Rate |
$3,327.37 |
| Rate for Payer: Aetna Commercial |
$3,091.24
|
| Rate for Payer: Cash Price |
$2,146.69
|
| Rate for Payer: Cigna All Commercial |
$3,087.66
|
| Rate for Payer: CORVEL All Commercial |
$3,327.37
|
| Rate for Payer: Coventry All Commercial |
$3,148.48
|
| Rate for Payer: Encore All Commercial |
$3,293.38
|
| Rate for Payer: Frontpath All Commercial |
$3,291.59
|
| Rate for Payer: Humana ChoiceCare |
$3,090.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,220.04
|
| Rate for Payer: PHCS All Commercial |
$2,683.36
|
| Rate for Payer: PHP All Commercial |
$2,713.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,762.08
|
| Rate for Payer: Signature Care EPO |
$2,969.59
|
| Rate for Payer: Signature Care PPO |
$3,148.48
|
| Rate for Payer: United Healthcare Commercial |
$2,819.32
|
|
|
HC Z PLATE LONG LOCK L
|
Facility
|
OP
|
$3,577.82
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,327.37 |
| Rate for Payer: Aetna Commercial |
$3,019.68
|
| Rate for Payer: Aetna Medicare |
$1,144.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,109.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,054.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,236.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,316.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,259.39
|
| Rate for Payer: Cash Price |
$2,146.69
|
| Rate for Payer: Cash Price |
$2,146.69
|
| Rate for Payer: Centivo All Commercial |
$1,946.33
|
| Rate for Payer: Cigna All Commercial |
$3,087.66
|
| Rate for Payer: CORVEL All Commercial |
$3,327.37
|
| Rate for Payer: Coventry All Commercial |
$3,148.48
|
| Rate for Payer: Encore All Commercial |
$3,293.38
|
| Rate for Payer: Frontpath All Commercial |
$3,291.59
|
| Rate for Payer: Humana ChoiceCare |
$3,090.16
|
| Rate for Payer: Humana Medicare |
$1,144.90
|
| Rate for Payer: Lucent All Commercial |
$1,946.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,220.04
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,683.36
|
| Rate for Payer: PHP All Commercial |
$2,713.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,395.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,762.08
|
| Rate for Payer: Signature Care EPO |
$2,969.59
|
| Rate for Payer: Signature Care PPO |
$3,148.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,041.15
|
| Rate for Payer: United Healthcare Commercial |
$2,819.32
|
| Rate for Payer: United Healthcare Medicare |
$1,144.90
|
|
|
HC Z PLATE MD LOCK L
|
Facility
|
OP
|
$3,337.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,104.20 |
| Rate for Payer: Aetna Commercial |
$2,817.15
|
| Rate for Payer: Aetna Medicare |
$1,068.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,034.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,916.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,086.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,228.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,174.92
|
| Rate for Payer: Cash Price |
$2,002.71
|
| Rate for Payer: Cash Price |
$2,002.71
|
| Rate for Payer: Centivo All Commercial |
$1,815.79
|
| Rate for Payer: Cigna All Commercial |
$2,880.56
|
| Rate for Payer: CORVEL All Commercial |
$3,104.20
|
| Rate for Payer: Coventry All Commercial |
$2,937.31
|
| Rate for Payer: Encore All Commercial |
$3,072.49
|
| Rate for Payer: Frontpath All Commercial |
$3,070.82
|
| Rate for Payer: Humana ChoiceCare |
$2,882.90
|
| Rate for Payer: Humana Medicare |
$1,068.11
|
| Rate for Payer: Lucent All Commercial |
$1,815.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,004.07
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,503.39
|
| Rate for Payer: PHP All Commercial |
$2,531.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,301.76
|
| Rate for Payer: Sagamore Health Network All Products |
$2,576.82
|
| Rate for Payer: Signature Care EPO |
$2,770.42
|
| Rate for Payer: Signature Care PPO |
$2,937.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,837.17
|
| Rate for Payer: United Healthcare Commercial |
$2,630.23
|
| Rate for Payer: United Healthcare Medicare |
$1,068.11
|
|
|
HC Z PLATE MD LOCK L
|
Facility
|
IP
|
$3,337.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,503.39 |
| Max. Negotiated Rate |
$3,104.20 |
| Rate for Payer: Aetna Commercial |
$2,883.90
|
| Rate for Payer: Cash Price |
$2,002.71
|
| Rate for Payer: Cigna All Commercial |
$2,880.56
|
| Rate for Payer: CORVEL All Commercial |
$3,104.20
|
| Rate for Payer: Coventry All Commercial |
$2,937.31
|
| Rate for Payer: Encore All Commercial |
$3,072.49
|
| Rate for Payer: Frontpath All Commercial |
$3,070.82
|
| Rate for Payer: Humana ChoiceCare |
$2,882.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,004.07
|
| Rate for Payer: PHCS All Commercial |
$2,503.39
|
| Rate for Payer: PHP All Commercial |
$2,531.43
|
| Rate for Payer: Sagamore Health Network All Products |
$2,576.82
|
| Rate for Payer: Signature Care EPO |
$2,770.42
|
| Rate for Payer: Signature Care PPO |
$2,937.31
|
| Rate for Payer: United Healthcare Commercial |
$2,630.23
|
|
|
HC Z PLATE MD LOCK R
|
Facility
|
IP
|
$3,337.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,503.39 |
| Max. Negotiated Rate |
$3,104.20 |
| Rate for Payer: Aetna Commercial |
$2,883.90
|
| Rate for Payer: Cash Price |
$2,002.71
|
| Rate for Payer: Cigna All Commercial |
$2,880.56
|
| Rate for Payer: CORVEL All Commercial |
$3,104.20
|
| Rate for Payer: Coventry All Commercial |
$2,937.31
|
| Rate for Payer: Encore All Commercial |
$3,072.49
|
| Rate for Payer: Frontpath All Commercial |
$3,070.82
|
| Rate for Payer: Humana ChoiceCare |
$2,882.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,004.07
|
| Rate for Payer: PHCS All Commercial |
$2,503.39
|
| Rate for Payer: PHP All Commercial |
$2,531.43
|
| Rate for Payer: Sagamore Health Network All Products |
$2,576.82
|
| Rate for Payer: Signature Care EPO |
$2,770.42
|
| Rate for Payer: Signature Care PPO |
$2,937.31
|
| Rate for Payer: United Healthcare Commercial |
$2,630.23
|
|
|
HC Z PLATE MD LOCK R
|
Facility
|
OP
|
$3,337.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,104.20 |
| Rate for Payer: Aetna Commercial |
$2,817.15
|
| Rate for Payer: Aetna Medicare |
$1,068.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,034.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,916.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,086.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,228.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,174.92
|
| Rate for Payer: Cash Price |
$2,002.71
|
| Rate for Payer: Cash Price |
$2,002.71
|
| Rate for Payer: Centivo All Commercial |
$1,815.79
|
| Rate for Payer: Cigna All Commercial |
$2,880.56
|
| Rate for Payer: CORVEL All Commercial |
$3,104.20
|
| Rate for Payer: Coventry All Commercial |
$2,937.31
|
| Rate for Payer: Encore All Commercial |
$3,072.49
|
| Rate for Payer: Frontpath All Commercial |
$3,070.82
|
| Rate for Payer: Humana ChoiceCare |
$2,882.90
|
| Rate for Payer: Humana Medicare |
$1,068.11
|
| Rate for Payer: Lucent All Commercial |
$1,815.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,004.07
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,503.39
|
| Rate for Payer: PHP All Commercial |
$2,531.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,301.76
|
| Rate for Payer: Sagamore Health Network All Products |
$2,576.82
|
| Rate for Payer: Signature Care EPO |
$2,770.42
|
| Rate for Payer: Signature Care PPO |
$2,937.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,837.17
|
| Rate for Payer: United Healthcare Commercial |
$2,630.23
|
| Rate for Payer: United Healthcare Medicare |
$1,068.11
|
|
|
HC Z PLATE MINI LOCK L
|
Facility
|
IP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,233.41 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,572.89
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
|
|
HC Z PLATE MINI LOCK L
|
Facility
|
OP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,513.33
|
| Rate for Payer: Aetna Medicare |
$952.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$923.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,710.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,861.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,095.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.21
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Centivo All Commercial |
$1,619.97
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Humana Medicare |
$952.92
|
| Rate for Payer: Lucent All Commercial |
$1,619.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,161.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,531.20
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
| Rate for Payer: United Healthcare Medicare |
$952.92
|
|
|
HC Z PLATE MINI LOCK R
|
Facility
|
IP
|
$3,945.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,959.20 |
| Max. Negotiated Rate |
$3,669.41 |
| Rate for Payer: Aetna Commercial |
$3,409.00
|
| Rate for Payer: Cash Price |
$2,367.36
|
| Rate for Payer: Cigna All Commercial |
$3,405.05
|
| Rate for Payer: CORVEL All Commercial |
$3,669.41
|
| Rate for Payer: Coventry All Commercial |
$3,472.13
|
| Rate for Payer: Encore All Commercial |
$3,631.92
|
| Rate for Payer: Frontpath All Commercial |
$3,629.95
|
| Rate for Payer: Humana ChoiceCare |
$3,407.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,551.04
|
| Rate for Payer: PHCS All Commercial |
$2,959.20
|
| Rate for Payer: PHP All Commercial |
$2,992.34
|
| Rate for Payer: Sagamore Health Network All Products |
$3,046.00
|
| Rate for Payer: Signature Care EPO |
$3,274.85
|
| Rate for Payer: Signature Care PPO |
$3,472.13
|
| Rate for Payer: United Healthcare Commercial |
$3,109.13
|
|
|
HC Z PLATE MINI LOCK R
|
Facility
|
OP
|
$3,945.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$3,669.41 |
| Rate for Payer: Aetna Commercial |
$3,330.09
|
| Rate for Payer: Aetna Medicare |
$1,262.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,223.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,265.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,466.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,451.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,388.85
|
| Rate for Payer: Cash Price |
$2,367.36
|
| Rate for Payer: Cash Price |
$2,367.36
|
| Rate for Payer: Centivo All Commercial |
$2,146.41
|
| Rate for Payer: Cigna All Commercial |
$3,405.05
|
| Rate for Payer: CORVEL All Commercial |
$3,669.41
|
| Rate for Payer: Coventry All Commercial |
$3,472.13
|
| Rate for Payer: Encore All Commercial |
$3,631.92
|
| Rate for Payer: Frontpath All Commercial |
$3,629.95
|
| Rate for Payer: Humana ChoiceCare |
$3,407.81
|
| Rate for Payer: Humana Medicare |
$1,262.59
|
| Rate for Payer: Lucent All Commercial |
$2,146.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,551.04
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,959.20
|
| Rate for Payer: PHP All Commercial |
$2,992.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,538.78
|
| Rate for Payer: Sagamore Health Network All Products |
$3,046.00
|
| Rate for Payer: Signature Care EPO |
$3,274.85
|
| Rate for Payer: Signature Care PPO |
$3,472.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,353.76
|
| Rate for Payer: United Healthcare Commercial |
$3,109.13
|
| Rate for Payer: United Healthcare Medicare |
$1,262.59
|
|
|
HC Z PLATE NARROW LOCK L
|
Facility
|
IP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,233.41 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,572.89
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
|
|
HC Z PLATE NARROW LOCK L
|
Facility
|
OP
|
$2,977.88
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,769.43 |
| Rate for Payer: Aetna Commercial |
$2,513.33
|
| Rate for Payer: Aetna Medicare |
$952.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$923.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,710.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,861.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,095.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.21
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Cash Price |
$1,786.73
|
| Rate for Payer: Centivo All Commercial |
$1,619.97
|
| Rate for Payer: Cigna All Commercial |
$2,569.91
|
| Rate for Payer: CORVEL All Commercial |
$2,769.43
|
| Rate for Payer: Coventry All Commercial |
$2,620.53
|
| Rate for Payer: Encore All Commercial |
$2,741.14
|
| Rate for Payer: Frontpath All Commercial |
$2,739.65
|
| Rate for Payer: Humana ChoiceCare |
$2,571.99
|
| Rate for Payer: Humana Medicare |
$952.92
|
| Rate for Payer: Lucent All Commercial |
$1,619.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,680.09
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,233.41
|
| Rate for Payer: PHP All Commercial |
$2,258.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,161.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2,298.92
|
| Rate for Payer: Signature Care EPO |
$2,471.64
|
| Rate for Payer: Signature Care PPO |
$2,620.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,531.20
|
| Rate for Payer: United Healthcare Commercial |
$2,346.57
|
| Rate for Payer: United Healthcare Medicare |
$952.92
|
|
|
HC Z PLATE PROX TIB 5H RT
|
Facility
|
OP
|
$4,457.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$4,145.70 |
| Rate for Payer: Aetna Commercial |
$3,762.33
|
| Rate for Payer: Aetna Medicare |
$1,426.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,381.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,560.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,786.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,640.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,569.12
|
| Rate for Payer: Cash Price |
$2,674.64
|
| Rate for Payer: Cash Price |
$2,674.64
|
| Rate for Payer: Centivo All Commercial |
$2,425.01
|
| Rate for Payer: Cigna All Commercial |
$3,847.03
|
| Rate for Payer: CORVEL All Commercial |
$4,145.70
|
| Rate for Payer: Coventry All Commercial |
$3,922.81
|
| Rate for Payer: Encore All Commercial |
$4,103.35
|
| Rate for Payer: Frontpath All Commercial |
$4,101.12
|
| Rate for Payer: Humana ChoiceCare |
$3,850.15
|
| Rate for Payer: Humana Medicare |
$1,426.48
|
| Rate for Payer: Lucent All Commercial |
$2,425.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,011.97
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$3,343.30
|
| Rate for Payer: PHP All Commercial |
$3,380.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,738.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3,441.38
|
| Rate for Payer: Signature Care EPO |
$3,699.92
|
| Rate for Payer: Signature Care PPO |
$3,922.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,789.08
|
| Rate for Payer: United Healthcare Commercial |
$3,512.70
|
| Rate for Payer: United Healthcare Medicare |
$1,426.48
|
|
|
HC Z PLATE PROX TIB 5H RT
|
Facility
|
IP
|
$4,457.74
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,343.30 |
| Max. Negotiated Rate |
$4,145.70 |
| Rate for Payer: Aetna Commercial |
$3,851.49
|
| Rate for Payer: Cash Price |
$2,674.64
|
| Rate for Payer: Cigna All Commercial |
$3,847.03
|
| Rate for Payer: CORVEL All Commercial |
$4,145.70
|
| Rate for Payer: Coventry All Commercial |
$3,922.81
|
| Rate for Payer: Encore All Commercial |
$4,103.35
|
| Rate for Payer: Frontpath All Commercial |
$4,101.12
|
| Rate for Payer: Humana ChoiceCare |
$3,850.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,011.97
|
| Rate for Payer: PHCS All Commercial |
$3,343.30
|
| Rate for Payer: PHP All Commercial |
$3,380.75
|
| Rate for Payer: Sagamore Health Network All Products |
$3,441.38
|
| Rate for Payer: Signature Care EPO |
$3,699.92
|
| Rate for Payer: Signature Care PPO |
$3,922.81
|
| Rate for Payer: United Healthcare Commercial |
$3,512.70
|
|
