|
HC W PLATE LT FIB LRG L
|
Facility
OP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,600.14
|
| Rate for Payer: Aetna Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,130.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,407.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,068.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,978.50
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Centivo All Commercial |
$2,779.70
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Humana Medicare |
$2,779.70
|
| Rate for Payer: Lucent All Commercial |
$2,779.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,125.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,632.84
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
| Rate for Payer: United Healthcare Medicare |
$1,798.63
|
|
|
HC W PLATE LT FIB LRG R
|
Facility
IP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,087.80 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,709.15
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
|
|
HC W PLATE LT FIB LRG R
|
Facility
OP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,600.14
|
| Rate for Payer: Aetna Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,130.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,407.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,068.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,978.50
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Centivo All Commercial |
$2,779.70
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Humana Medicare |
$2,779.70
|
| Rate for Payer: Lucent All Commercial |
$2,779.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,125.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,632.84
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
| Rate for Payer: United Healthcare Medicare |
$1,798.63
|
|
|
HC W PLATE LT FIB MED L
|
Facility
IP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,087.80 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,709.15
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
|
|
HC W PLATE LT FIB MED L
|
Facility
OP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,600.14
|
| Rate for Payer: Aetna Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,130.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,407.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,068.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,978.50
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Centivo All Commercial |
$2,779.70
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Humana Medicare |
$2,779.70
|
| Rate for Payer: Lucent All Commercial |
$2,779.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,125.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,632.84
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
| Rate for Payer: United Healthcare Medicare |
$1,798.63
|
|
|
HC W PLATE LT FIB MED R
|
Facility
OP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,600.14
|
| Rate for Payer: Aetna Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,130.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,407.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,068.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,978.50
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Centivo All Commercial |
$2,779.70
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Humana Medicare |
$2,779.70
|
| Rate for Payer: Lucent All Commercial |
$2,779.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,125.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,632.84
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
| Rate for Payer: United Healthcare Medicare |
$1,798.63
|
|
|
HC W PLATE LT FIB MED R
|
Facility
IP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,087.80 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,709.15
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
|
|
HC W PLATE LT FIB SM L
|
Facility
IP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,087.80 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,709.15
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
|
|
HC W PLATE LT FIB SM L
|
Facility
OP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,600.14
|
| Rate for Payer: Aetna Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,130.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,407.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,068.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,978.50
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Centivo All Commercial |
$2,779.70
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Humana Medicare |
$2,779.70
|
| Rate for Payer: Lucent All Commercial |
$2,779.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,125.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,632.84
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
| Rate for Payer: United Healthcare Medicare |
$1,798.63
|
|
|
HC W PLATE LT FIB SM R
|
Facility
IP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,087.80 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,709.15
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
|
|
HC W PLATE LT FIB SM R
|
Facility
OP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,068.87 |
| Rate for Payer: Aetna Commercial |
$4,600.14
|
| Rate for Payer: Aetna Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,798.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,130.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,407.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,068.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,978.50
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Cash Price |
$3,379.25
|
| Rate for Payer: Centivo All Commercial |
$2,779.70
|
| Rate for Payer: Cigna All Commercial |
$4,703.70
|
| Rate for Payer: CORVEL All Commercial |
$5,068.87
|
| Rate for Payer: Coventry All Commercial |
$4,796.35
|
| Rate for Payer: Encore All Commercial |
$5,017.09
|
| Rate for Payer: Frontpath All Commercial |
$5,014.37
|
| Rate for Payer: Humana ChoiceCare |
$4,707.51
|
| Rate for Payer: Humana Medicare |
$2,779.70
|
| Rate for Payer: Lucent All Commercial |
$2,779.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,905.36
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,087.80
|
| Rate for Payer: PHP All Commercial |
$4,133.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,125.66
|
| Rate for Payer: Sagamore Health Network All Products |
$4,207.71
|
| Rate for Payer: Signature Care EPO |
$4,523.83
|
| Rate for Payer: Signature Care PPO |
$4,796.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,632.84
|
| Rate for Payer: United Healthcare Commercial |
$4,294.92
|
| Rate for Payer: United Healthcare Medicare |
$1,798.63
|
|
|
HC W PLATE LT TTC FUSION LRG L
|
Facility
OP
|
$7,617.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,084.37 |
| Rate for Payer: Aetna Commercial |
$6,429.25
|
| Rate for Payer: Aetna Medicare |
$2,513.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,513.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,374.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,761.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,890.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,765.19
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Centivo All Commercial |
$3,884.98
|
| Rate for Payer: Cigna All Commercial |
$6,573.99
|
| Rate for Payer: CORVEL All Commercial |
$7,084.37
|
| Rate for Payer: Coventry All Commercial |
$6,703.49
|
| Rate for Payer: Encore All Commercial |
$7,012.00
|
| Rate for Payer: Frontpath All Commercial |
$7,008.19
|
| Rate for Payer: Humana ChoiceCare |
$6,579.32
|
| Rate for Payer: Humana Medicare |
$3,884.98
|
| Rate for Payer: Lucent All Commercial |
$3,884.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,855.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,713.20
|
| Rate for Payer: PHP All Commercial |
$5,777.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,970.86
|
| Rate for Payer: Sagamore Health Network All Products |
$5,880.79
|
| Rate for Payer: Signature Care EPO |
$6,322.61
|
| Rate for Payer: Signature Care PPO |
$6,703.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,474.96
|
| Rate for Payer: United Healthcare Commercial |
$6,002.67
|
| Rate for Payer: United Healthcare Medicare |
$2,513.81
|
|
|
HC W PLATE LT TTC FUSION LRG L
|
Facility
IP
|
$7,617.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,713.20 |
| Max. Negotiated Rate |
$7,084.37 |
| Rate for Payer: Aetna Commercial |
$6,581.61
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Cigna All Commercial |
$6,573.99
|
| Rate for Payer: CORVEL All Commercial |
$7,084.37
|
| Rate for Payer: Coventry All Commercial |
$6,703.49
|
| Rate for Payer: Encore All Commercial |
$7,012.00
|
| Rate for Payer: Frontpath All Commercial |
$7,008.19
|
| Rate for Payer: Humana ChoiceCare |
$6,579.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,855.84
|
| Rate for Payer: PHCS All Commercial |
$5,713.20
|
| Rate for Payer: PHP All Commercial |
$5,777.19
|
| Rate for Payer: Sagamore Health Network All Products |
$5,880.79
|
| Rate for Payer: Signature Care EPO |
$6,322.61
|
| Rate for Payer: Signature Care PPO |
$6,703.49
|
| Rate for Payer: United Healthcare Commercial |
$6,002.67
|
|
|
HC W PLATE LT TTC FUSION LRG R
|
Facility
OP
|
$7,617.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,084.37 |
| Rate for Payer: Aetna Commercial |
$6,429.25
|
| Rate for Payer: Aetna Medicare |
$2,513.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,513.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,374.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,761.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,890.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,765.19
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Centivo All Commercial |
$3,884.98
|
| Rate for Payer: Cigna All Commercial |
$6,573.99
|
| Rate for Payer: CORVEL All Commercial |
$7,084.37
|
| Rate for Payer: Coventry All Commercial |
$6,703.49
|
| Rate for Payer: Encore All Commercial |
$7,012.00
|
| Rate for Payer: Frontpath All Commercial |
$7,008.19
|
| Rate for Payer: Humana ChoiceCare |
$6,579.32
|
| Rate for Payer: Humana Medicare |
$3,884.98
|
| Rate for Payer: Lucent All Commercial |
$3,884.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,855.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,713.20
|
| Rate for Payer: PHP All Commercial |
$5,777.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,970.86
|
| Rate for Payer: Sagamore Health Network All Products |
$5,880.79
|
| Rate for Payer: Signature Care EPO |
$6,322.61
|
| Rate for Payer: Signature Care PPO |
$6,703.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,474.96
|
| Rate for Payer: United Healthcare Commercial |
$6,002.67
|
| Rate for Payer: United Healthcare Medicare |
$2,513.81
|
|
|
HC W PLATE LT TTC FUSION LRG R
|
Facility
IP
|
$7,617.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,713.20 |
| Max. Negotiated Rate |
$7,084.37 |
| Rate for Payer: Aetna Commercial |
$6,581.61
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Cigna All Commercial |
$6,573.99
|
| Rate for Payer: CORVEL All Commercial |
$7,084.37
|
| Rate for Payer: Coventry All Commercial |
$6,703.49
|
| Rate for Payer: Encore All Commercial |
$7,012.00
|
| Rate for Payer: Frontpath All Commercial |
$7,008.19
|
| Rate for Payer: Humana ChoiceCare |
$6,579.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,855.84
|
| Rate for Payer: PHCS All Commercial |
$5,713.20
|
| Rate for Payer: PHP All Commercial |
$5,777.19
|
| Rate for Payer: Sagamore Health Network All Products |
$5,880.79
|
| Rate for Payer: Signature Care EPO |
$6,322.61
|
| Rate for Payer: Signature Care PPO |
$6,703.49
|
| Rate for Payer: United Healthcare Commercial |
$6,002.67
|
|
|
HC W PLATE LT TTC FUSION SM L
|
Facility
OP
|
$7,617.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,084.37 |
| Rate for Payer: Aetna Commercial |
$6,429.25
|
| Rate for Payer: Aetna Medicare |
$2,513.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,513.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,374.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,761.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,890.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,765.19
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Centivo All Commercial |
$3,884.98
|
| Rate for Payer: Cigna All Commercial |
$6,573.99
|
| Rate for Payer: CORVEL All Commercial |
$7,084.37
|
| Rate for Payer: Coventry All Commercial |
$6,703.49
|
| Rate for Payer: Encore All Commercial |
$7,012.00
|
| Rate for Payer: Frontpath All Commercial |
$7,008.19
|
| Rate for Payer: Humana ChoiceCare |
$6,579.32
|
| Rate for Payer: Humana Medicare |
$3,884.98
|
| Rate for Payer: Lucent All Commercial |
$3,884.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,855.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,713.20
|
| Rate for Payer: PHP All Commercial |
$5,777.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,970.86
|
| Rate for Payer: Sagamore Health Network All Products |
$5,880.79
|
| Rate for Payer: Signature Care EPO |
$6,322.61
|
| Rate for Payer: Signature Care PPO |
$6,703.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,474.96
|
| Rate for Payer: United Healthcare Commercial |
$6,002.67
|
| Rate for Payer: United Healthcare Medicare |
$2,513.81
|
|
|
HC W PLATE LT TTC FUSION SM L
|
Facility
IP
|
$7,617.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,713.20 |
| Max. Negotiated Rate |
$7,084.37 |
| Rate for Payer: Aetna Commercial |
$6,581.61
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Cigna All Commercial |
$6,573.99
|
| Rate for Payer: CORVEL All Commercial |
$7,084.37
|
| Rate for Payer: Coventry All Commercial |
$6,703.49
|
| Rate for Payer: Encore All Commercial |
$7,012.00
|
| Rate for Payer: Frontpath All Commercial |
$7,008.19
|
| Rate for Payer: Humana ChoiceCare |
$6,579.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,855.84
|
| Rate for Payer: PHCS All Commercial |
$5,713.20
|
| Rate for Payer: PHP All Commercial |
$5,777.19
|
| Rate for Payer: Sagamore Health Network All Products |
$5,880.79
|
| Rate for Payer: Signature Care EPO |
$6,322.61
|
| Rate for Payer: Signature Care PPO |
$6,703.49
|
| Rate for Payer: United Healthcare Commercial |
$6,002.67
|
|
|
HC W PLATE LT TTC FUSION SM R
|
Facility
OP
|
$7,617.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,084.37 |
| Rate for Payer: Aetna Commercial |
$6,429.25
|
| Rate for Payer: Aetna Medicare |
$2,513.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,513.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,374.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,761.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,890.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,765.19
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Centivo All Commercial |
$3,884.98
|
| Rate for Payer: Cigna All Commercial |
$6,573.99
|
| Rate for Payer: CORVEL All Commercial |
$7,084.37
|
| Rate for Payer: Coventry All Commercial |
$6,703.49
|
| Rate for Payer: Encore All Commercial |
$7,012.00
|
| Rate for Payer: Frontpath All Commercial |
$7,008.19
|
| Rate for Payer: Humana ChoiceCare |
$6,579.32
|
| Rate for Payer: Humana Medicare |
$3,884.98
|
| Rate for Payer: Lucent All Commercial |
$3,884.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,855.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,713.20
|
| Rate for Payer: PHP All Commercial |
$5,777.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,970.86
|
| Rate for Payer: Sagamore Health Network All Products |
$5,880.79
|
| Rate for Payer: Signature Care EPO |
$6,322.61
|
| Rate for Payer: Signature Care PPO |
$6,703.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,474.96
|
| Rate for Payer: United Healthcare Commercial |
$6,002.67
|
| Rate for Payer: United Healthcare Medicare |
$2,513.81
|
|
|
HC W PLATE LT TTC FUSION SM R
|
Facility
IP
|
$7,617.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,713.20 |
| Max. Negotiated Rate |
$7,084.37 |
| Rate for Payer: Aetna Commercial |
$6,581.61
|
| Rate for Payer: Cash Price |
$4,722.91
|
| Rate for Payer: Cigna All Commercial |
$6,573.99
|
| Rate for Payer: CORVEL All Commercial |
$7,084.37
|
| Rate for Payer: Coventry All Commercial |
$6,703.49
|
| Rate for Payer: Encore All Commercial |
$7,012.00
|
| Rate for Payer: Frontpath All Commercial |
$7,008.19
|
| Rate for Payer: Humana ChoiceCare |
$6,579.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,855.84
|
| Rate for Payer: PHCS All Commercial |
$5,713.20
|
| Rate for Payer: PHP All Commercial |
$5,777.19
|
| Rate for Payer: Sagamore Health Network All Products |
$5,880.79
|
| Rate for Payer: Signature Care EPO |
$6,322.61
|
| Rate for Payer: Signature Care PPO |
$6,703.49
|
| Rate for Payer: United Healthcare Commercial |
$6,002.67
|
|
|
HC W PLATE LT TT FUSION LRG
|
Facility
IP
|
$6,991.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.40 |
| Max. Negotiated Rate |
$6,501.82 |
| Rate for Payer: Aetna Commercial |
$6,040.40
|
| Rate for Payer: Cash Price |
$4,334.54
|
| Rate for Payer: Cigna All Commercial |
$6,033.41
|
| Rate for Payer: CORVEL All Commercial |
$6,501.82
|
| Rate for Payer: Coventry All Commercial |
$6,152.26
|
| Rate for Payer: Encore All Commercial |
$6,435.40
|
| Rate for Payer: Frontpath All Commercial |
$6,431.90
|
| Rate for Payer: Humana ChoiceCare |
$6,038.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,292.08
|
| Rate for Payer: PHCS All Commercial |
$5,243.40
|
| Rate for Payer: PHP All Commercial |
$5,302.13
|
| Rate for Payer: Sagamore Health Network All Products |
$5,397.21
|
| Rate for Payer: Signature Care EPO |
$5,802.70
|
| Rate for Payer: Signature Care PPO |
$6,152.26
|
| Rate for Payer: United Healthcare Commercial |
$5,509.07
|
|
|
HC W PLATE LT TT FUSION LRG
|
Facility
OP
|
$6,991.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,501.82 |
| Rate for Payer: Aetna Commercial |
$5,900.57
|
| Rate for Payer: Aetna Medicare |
$2,307.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,307.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,015.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,370.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,653.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,537.81
|
| Rate for Payer: Cash Price |
$4,334.54
|
| Rate for Payer: Cash Price |
$4,334.54
|
| Rate for Payer: Centivo All Commercial |
$3,565.51
|
| Rate for Payer: Cigna All Commercial |
$6,033.41
|
| Rate for Payer: CORVEL All Commercial |
$6,501.82
|
| Rate for Payer: Coventry All Commercial |
$6,152.26
|
| Rate for Payer: Encore All Commercial |
$6,435.40
|
| Rate for Payer: Frontpath All Commercial |
$6,431.90
|
| Rate for Payer: Humana ChoiceCare |
$6,038.30
|
| Rate for Payer: Humana Medicare |
$3,565.51
|
| Rate for Payer: Lucent All Commercial |
$3,565.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,292.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,243.40
|
| Rate for Payer: PHP All Commercial |
$5,302.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,726.57
|
| Rate for Payer: Sagamore Health Network All Products |
$5,397.21
|
| Rate for Payer: Signature Care EPO |
$5,802.70
|
| Rate for Payer: Signature Care PPO |
$6,152.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,942.52
|
| Rate for Payer: United Healthcare Commercial |
$5,509.07
|
| Rate for Payer: United Healthcare Medicare |
$2,307.10
|
|
|
HC W PLATE LT TT FUSION SM
|
Facility
OP
|
$6,991.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,501.82 |
| Rate for Payer: Aetna Commercial |
$5,900.57
|
| Rate for Payer: Aetna Medicare |
$2,307.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,307.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,015.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,370.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,653.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,537.81
|
| Rate for Payer: Cash Price |
$4,334.54
|
| Rate for Payer: Cash Price |
$4,334.54
|
| Rate for Payer: Centivo All Commercial |
$3,565.51
|
| Rate for Payer: Cigna All Commercial |
$6,033.41
|
| Rate for Payer: CORVEL All Commercial |
$6,501.82
|
| Rate for Payer: Coventry All Commercial |
$6,152.26
|
| Rate for Payer: Encore All Commercial |
$6,435.40
|
| Rate for Payer: Frontpath All Commercial |
$6,431.90
|
| Rate for Payer: Humana ChoiceCare |
$6,038.30
|
| Rate for Payer: Humana Medicare |
$3,565.51
|
| Rate for Payer: Lucent All Commercial |
$3,565.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,292.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,243.40
|
| Rate for Payer: PHP All Commercial |
$5,302.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,726.57
|
| Rate for Payer: Sagamore Health Network All Products |
$5,397.21
|
| Rate for Payer: Signature Care EPO |
$5,802.70
|
| Rate for Payer: Signature Care PPO |
$6,152.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,942.52
|
| Rate for Payer: United Healthcare Commercial |
$5,509.07
|
| Rate for Payer: United Healthcare Medicare |
$2,307.10
|
|
|
HC W PLATE LT TT FUSION SM
|
Facility
IP
|
$6,991.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.40 |
| Max. Negotiated Rate |
$6,501.82 |
| Rate for Payer: Aetna Commercial |
$6,040.40
|
| Rate for Payer: Cash Price |
$4,334.54
|
| Rate for Payer: Cigna All Commercial |
$6,033.41
|
| Rate for Payer: CORVEL All Commercial |
$6,501.82
|
| Rate for Payer: Coventry All Commercial |
$6,152.26
|
| Rate for Payer: Encore All Commercial |
$6,435.40
|
| Rate for Payer: Frontpath All Commercial |
$6,431.90
|
| Rate for Payer: Humana ChoiceCare |
$6,038.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,292.08
|
| Rate for Payer: PHCS All Commercial |
$5,243.40
|
| Rate for Payer: PHP All Commercial |
$5,302.13
|
| Rate for Payer: Sagamore Health Network All Products |
$5,397.21
|
| Rate for Payer: Signature Care EPO |
$5,802.70
|
| Rate for Payer: Signature Care PPO |
$6,152.26
|
| Rate for Payer: United Healthcare Commercial |
$5,509.07
|
|
|
HC W PLATE MD COLUMN FUSION LRG
|
Facility
OP
|
$7,218.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,712.74 |
| Rate for Payer: Aetna Commercial |
$6,091.99
|
| Rate for Payer: Aetna Medicare |
$2,381.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,381.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,145.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,511.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,739.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,620.13
|
| Rate for Payer: Cash Price |
$4,475.16
|
| Rate for Payer: Cash Price |
$4,475.16
|
| Rate for Payer: Centivo All Commercial |
$3,681.18
|
| Rate for Payer: Cigna All Commercial |
$6,229.13
|
| Rate for Payer: CORVEL All Commercial |
$6,712.74
|
| Rate for Payer: Coventry All Commercial |
$6,351.84
|
| Rate for Payer: Encore All Commercial |
$6,644.17
|
| Rate for Payer: Frontpath All Commercial |
$6,640.56
|
| Rate for Payer: Humana ChoiceCare |
$6,234.19
|
| Rate for Payer: Humana Medicare |
$3,681.18
|
| Rate for Payer: Lucent All Commercial |
$3,681.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,496.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,413.50
|
| Rate for Payer: PHP All Commercial |
$5,474.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,815.02
|
| Rate for Payer: Sagamore Health Network All Products |
$5,572.30
|
| Rate for Payer: Signature Care EPO |
$5,990.94
|
| Rate for Payer: Signature Care PPO |
$6,351.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,135.30
|
| Rate for Payer: United Healthcare Commercial |
$5,687.78
|
| Rate for Payer: United Healthcare Medicare |
$2,381.94
|
|
|
HC W PLATE MD COLUMN FUSION LRG
|
Facility
IP
|
$7,218.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,413.50 |
| Max. Negotiated Rate |
$6,712.74 |
| Rate for Payer: Aetna Commercial |
$6,236.35
|
| Rate for Payer: Cash Price |
$4,475.16
|
| Rate for Payer: Cigna All Commercial |
$6,229.13
|
| Rate for Payer: CORVEL All Commercial |
$6,712.74
|
| Rate for Payer: Coventry All Commercial |
$6,351.84
|
| Rate for Payer: Encore All Commercial |
$6,644.17
|
| Rate for Payer: Frontpath All Commercial |
$6,640.56
|
| Rate for Payer: Humana ChoiceCare |
$6,234.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,496.20
|
| Rate for Payer: PHCS All Commercial |
$5,413.50
|
| Rate for Payer: PHP All Commercial |
$5,474.13
|
| Rate for Payer: Sagamore Health Network All Products |
$5,572.30
|
| Rate for Payer: Signature Care EPO |
$5,990.94
|
| Rate for Payer: Signature Care PPO |
$6,351.84
|
| Rate for Payer: United Healthcare Commercial |
$5,687.78
|
|
