|
HC W PLATE MD TIB MED R
|
Facility
OP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,645.78 |
| Rate for Payer: Aetna Commercial |
$6,031.22
|
| Rate for Payer: Aetna Medicare |
$2,358.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,358.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,103.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,466.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,711.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,594.00
|
| Rate for Payer: Cash Price |
$4,430.52
|
| Rate for Payer: Cash Price |
$4,430.52
|
| Rate for Payer: Centivo All Commercial |
$3,644.46
|
| Rate for Payer: Cigna All Commercial |
$6,167.00
|
| Rate for Payer: CORVEL All Commercial |
$6,645.78
|
| Rate for Payer: Coventry All Commercial |
$6,288.48
|
| Rate for Payer: Encore All Commercial |
$6,577.89
|
| Rate for Payer: Frontpath All Commercial |
$6,574.32
|
| Rate for Payer: Humana ChoiceCare |
$6,172.00
|
| Rate for Payer: Humana Medicare |
$3,644.46
|
| Rate for Payer: Lucent All Commercial |
$3,644.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,431.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,359.50
|
| Rate for Payer: PHP All Commercial |
$5,419.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,786.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5,516.71
|
| Rate for Payer: Signature Care EPO |
$5,931.18
|
| Rate for Payer: Signature Care PPO |
$6,288.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,074.10
|
| Rate for Payer: United Healthcare Commercial |
$5,631.05
|
| Rate for Payer: United Healthcare Medicare |
$2,358.18
|
|
|
HC W PLATE MD TIB SM
|
Facility
IP
|
$5,007.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,755.70 |
| Max. Negotiated Rate |
$4,657.07 |
| Rate for Payer: Aetna Commercial |
$4,326.57
|
| Rate for Payer: Cash Price |
$3,104.71
|
| Rate for Payer: Cigna All Commercial |
$4,321.56
|
| Rate for Payer: CORVEL All Commercial |
$4,657.07
|
| Rate for Payer: Coventry All Commercial |
$4,406.69
|
| Rate for Payer: Encore All Commercial |
$4,609.50
|
| Rate for Payer: Frontpath All Commercial |
$4,606.99
|
| Rate for Payer: Humana ChoiceCare |
$4,325.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,506.84
|
| Rate for Payer: PHCS All Commercial |
$3,755.70
|
| Rate for Payer: PHP All Commercial |
$3,797.76
|
| Rate for Payer: Sagamore Health Network All Products |
$3,865.87
|
| Rate for Payer: Signature Care EPO |
$4,156.31
|
| Rate for Payer: Signature Care PPO |
$4,406.69
|
| Rate for Payer: United Healthcare Commercial |
$3,945.99
|
|
|
HC W PLATE MD TIB SM
|
Facility
OP
|
$5,007.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,657.07 |
| Rate for Payer: Aetna Commercial |
$4,226.41
|
| Rate for Payer: Aetna Medicare |
$1,652.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,652.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,875.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,130.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,900.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,817.76
|
| Rate for Payer: Cash Price |
$3,104.71
|
| Rate for Payer: Cash Price |
$3,104.71
|
| Rate for Payer: Centivo All Commercial |
$2,553.88
|
| Rate for Payer: Cigna All Commercial |
$4,321.56
|
| Rate for Payer: CORVEL All Commercial |
$4,657.07
|
| Rate for Payer: Coventry All Commercial |
$4,406.69
|
| Rate for Payer: Encore All Commercial |
$4,609.50
|
| Rate for Payer: Frontpath All Commercial |
$4,606.99
|
| Rate for Payer: Humana ChoiceCare |
$4,325.06
|
| Rate for Payer: Humana Medicare |
$2,553.88
|
| Rate for Payer: Lucent All Commercial |
$2,553.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,506.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,755.70
|
| Rate for Payer: PHP All Commercial |
$3,797.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,952.96
|
| Rate for Payer: Sagamore Health Network All Products |
$3,865.87
|
| Rate for Payer: Signature Care EPO |
$4,156.31
|
| Rate for Payer: Signature Care PPO |
$4,406.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,256.46
|
| Rate for Payer: United Healthcare Commercial |
$3,945.99
|
| Rate for Payer: United Healthcare Medicare |
$1,652.51
|
|
|
HC W PLATE MD TIB SM L
|
Facility
IP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,359.50 |
| Max. Negotiated Rate |
$6,645.78 |
| Rate for Payer: Aetna Commercial |
$6,174.14
|
| Rate for Payer: Cash Price |
$4,430.52
|
| Rate for Payer: Cigna All Commercial |
$6,167.00
|
| Rate for Payer: CORVEL All Commercial |
$6,645.78
|
| Rate for Payer: Coventry All Commercial |
$6,288.48
|
| Rate for Payer: Encore All Commercial |
$6,577.89
|
| Rate for Payer: Frontpath All Commercial |
$6,574.32
|
| Rate for Payer: Humana ChoiceCare |
$6,172.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,431.40
|
| Rate for Payer: PHCS All Commercial |
$5,359.50
|
| Rate for Payer: PHP All Commercial |
$5,419.53
|
| Rate for Payer: Sagamore Health Network All Products |
$5,516.71
|
| Rate for Payer: Signature Care EPO |
$5,931.18
|
| Rate for Payer: Signature Care PPO |
$6,288.48
|
| Rate for Payer: United Healthcare Commercial |
$5,631.05
|
|
|
HC W PLATE MD TIB SM L
|
Facility
OP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,645.78 |
| Rate for Payer: Aetna Commercial |
$6,031.22
|
| Rate for Payer: Aetna Medicare |
$2,358.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,358.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,103.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,466.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,711.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,594.00
|
| Rate for Payer: Cash Price |
$4,430.52
|
| Rate for Payer: Cash Price |
$4,430.52
|
| Rate for Payer: Centivo All Commercial |
$3,644.46
|
| Rate for Payer: Cigna All Commercial |
$6,167.00
|
| Rate for Payer: CORVEL All Commercial |
$6,645.78
|
| Rate for Payer: Coventry All Commercial |
$6,288.48
|
| Rate for Payer: Encore All Commercial |
$6,577.89
|
| Rate for Payer: Frontpath All Commercial |
$6,574.32
|
| Rate for Payer: Humana ChoiceCare |
$6,172.00
|
| Rate for Payer: Humana Medicare |
$3,644.46
|
| Rate for Payer: Lucent All Commercial |
$3,644.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,431.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,359.50
|
| Rate for Payer: PHP All Commercial |
$5,419.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,786.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5,516.71
|
| Rate for Payer: Signature Care EPO |
$5,931.18
|
| Rate for Payer: Signature Care PPO |
$6,288.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,074.10
|
| Rate for Payer: United Healthcare Commercial |
$5,631.05
|
| Rate for Payer: United Healthcare Medicare |
$2,358.18
|
|
|
HC W PLATE MD TIB SM R
|
Facility
OP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,645.78 |
| Rate for Payer: Aetna Commercial |
$6,031.22
|
| Rate for Payer: Aetna Medicare |
$2,358.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,358.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,103.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,466.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,711.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,594.00
|
| Rate for Payer: Cash Price |
$4,430.52
|
| Rate for Payer: Cash Price |
$4,430.52
|
| Rate for Payer: Centivo All Commercial |
$3,644.46
|
| Rate for Payer: Cigna All Commercial |
$6,167.00
|
| Rate for Payer: CORVEL All Commercial |
$6,645.78
|
| Rate for Payer: Coventry All Commercial |
$6,288.48
|
| Rate for Payer: Encore All Commercial |
$6,577.89
|
| Rate for Payer: Frontpath All Commercial |
$6,574.32
|
| Rate for Payer: Humana ChoiceCare |
$6,172.00
|
| Rate for Payer: Humana Medicare |
$3,644.46
|
| Rate for Payer: Lucent All Commercial |
$3,644.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,431.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,359.50
|
| Rate for Payer: PHP All Commercial |
$5,419.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,786.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5,516.71
|
| Rate for Payer: Signature Care EPO |
$5,931.18
|
| Rate for Payer: Signature Care PPO |
$6,288.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,074.10
|
| Rate for Payer: United Healthcare Commercial |
$5,631.05
|
| Rate for Payer: United Healthcare Medicare |
$2,358.18
|
|
|
HC W PLATE MD TIB SM R
|
Facility
IP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,359.50 |
| Max. Negotiated Rate |
$6,645.78 |
| Rate for Payer: Aetna Commercial |
$6,174.14
|
| Rate for Payer: Cash Price |
$4,430.52
|
| Rate for Payer: Cigna All Commercial |
$6,167.00
|
| Rate for Payer: CORVEL All Commercial |
$6,645.78
|
| Rate for Payer: Coventry All Commercial |
$6,288.48
|
| Rate for Payer: Encore All Commercial |
$6,577.89
|
| Rate for Payer: Frontpath All Commercial |
$6,574.32
|
| Rate for Payer: Humana ChoiceCare |
$6,172.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,431.40
|
| Rate for Payer: PHCS All Commercial |
$5,359.50
|
| Rate for Payer: PHP All Commercial |
$5,419.53
|
| Rate for Payer: Sagamore Health Network All Products |
$5,516.71
|
| Rate for Payer: Signature Care EPO |
$5,931.18
|
| Rate for Payer: Signature Care PPO |
$6,288.48
|
| Rate for Payer: United Healthcare Commercial |
$5,631.05
|
|
|
HC W PLATE MID FUSION SM L
|
Facility
IP
|
$6,804.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,103.00 |
| Max. Negotiated Rate |
$6,327.72 |
| Rate for Payer: Aetna Commercial |
$5,878.66
|
| Rate for Payer: Cash Price |
$4,218.48
|
| Rate for Payer: Cigna All Commercial |
$5,871.85
|
| Rate for Payer: CORVEL All Commercial |
$6,327.72
|
| Rate for Payer: Coventry All Commercial |
$5,987.52
|
| Rate for Payer: Encore All Commercial |
$6,263.08
|
| Rate for Payer: Frontpath All Commercial |
$6,259.68
|
| Rate for Payer: Humana ChoiceCare |
$5,876.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,123.60
|
| Rate for Payer: PHCS All Commercial |
$5,103.00
|
| Rate for Payer: PHP All Commercial |
$5,160.15
|
| Rate for Payer: Sagamore Health Network All Products |
$5,252.69
|
| Rate for Payer: Signature Care EPO |
$5,647.32
|
| Rate for Payer: Signature Care PPO |
$5,987.52
|
| Rate for Payer: United Healthcare Commercial |
$5,361.55
|
|
|
HC W PLATE MID FUSION SM L
|
Facility
OP
|
$6,804.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,327.72 |
| Rate for Payer: Aetna Commercial |
$5,742.58
|
| Rate for Payer: Aetna Medicare |
$2,245.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,245.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,907.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,253.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,582.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,469.85
|
| Rate for Payer: Cash Price |
$4,218.48
|
| Rate for Payer: Cash Price |
$4,218.48
|
| Rate for Payer: Centivo All Commercial |
$3,470.04
|
| Rate for Payer: Cigna All Commercial |
$5,871.85
|
| Rate for Payer: CORVEL All Commercial |
$6,327.72
|
| Rate for Payer: Coventry All Commercial |
$5,987.52
|
| Rate for Payer: Encore All Commercial |
$6,263.08
|
| Rate for Payer: Frontpath All Commercial |
$6,259.68
|
| Rate for Payer: Humana ChoiceCare |
$5,876.61
|
| Rate for Payer: Humana Medicare |
$3,470.04
|
| Rate for Payer: Lucent All Commercial |
$3,470.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,123.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,103.00
|
| Rate for Payer: PHP All Commercial |
$5,160.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,653.56
|
| Rate for Payer: Sagamore Health Network All Products |
$5,252.69
|
| Rate for Payer: Signature Care EPO |
$5,647.32
|
| Rate for Payer: Signature Care PPO |
$5,987.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,783.40
|
| Rate for Payer: United Healthcare Commercial |
$5,361.55
|
| Rate for Payer: United Healthcare Medicare |
$2,245.32
|
|
|
HC W PLATE MPJ LARGE
|
Facility
IP
|
$4,744.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,558.60 |
| Max. Negotiated Rate |
$4,412.66 |
| Rate for Payer: Aetna Commercial |
$4,099.51
|
| Rate for Payer: Cash Price |
$2,941.78
|
| Rate for Payer: Cigna All Commercial |
$4,094.76
|
| Rate for Payer: CORVEL All Commercial |
$4,412.66
|
| Rate for Payer: Coventry All Commercial |
$4,175.42
|
| Rate for Payer: Encore All Commercial |
$4,367.59
|
| Rate for Payer: Frontpath All Commercial |
$4,365.22
|
| Rate for Payer: Humana ChoiceCare |
$4,098.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,270.32
|
| Rate for Payer: PHCS All Commercial |
$3,558.60
|
| Rate for Payer: PHP All Commercial |
$3,598.46
|
| Rate for Payer: Sagamore Health Network All Products |
$3,662.99
|
| Rate for Payer: Signature Care EPO |
$3,938.18
|
| Rate for Payer: Signature Care PPO |
$4,175.42
|
| Rate for Payer: United Healthcare Commercial |
$3,738.90
|
|
|
HC W PLATE MPJ LARGE
|
Facility
OP
|
$4,744.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,412.66 |
| Rate for Payer: Aetna Commercial |
$4,004.61
|
| Rate for Payer: Aetna Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,724.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,965.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,800.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,722.36
|
| Rate for Payer: Cash Price |
$2,941.78
|
| Rate for Payer: Cash Price |
$2,941.78
|
| Rate for Payer: Centivo All Commercial |
$2,419.85
|
| Rate for Payer: Cigna All Commercial |
$4,094.76
|
| Rate for Payer: CORVEL All Commercial |
$4,412.66
|
| Rate for Payer: Coventry All Commercial |
$4,175.42
|
| Rate for Payer: Encore All Commercial |
$4,367.59
|
| Rate for Payer: Frontpath All Commercial |
$4,365.22
|
| Rate for Payer: Humana ChoiceCare |
$4,098.08
|
| Rate for Payer: Humana Medicare |
$2,419.85
|
| Rate for Payer: Lucent All Commercial |
$2,419.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,270.32
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,558.60
|
| Rate for Payer: PHP All Commercial |
$3,598.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,850.47
|
| Rate for Payer: Sagamore Health Network All Products |
$3,662.99
|
| Rate for Payer: Signature Care EPO |
$3,938.18
|
| Rate for Payer: Signature Care PPO |
$4,175.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,033.08
|
| Rate for Payer: United Healthcare Commercial |
$3,738.90
|
| Rate for Payer: United Healthcare Medicare |
$1,565.78
|
|
|
HC W PLATE MTP L
|
Facility
OP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,201.37
|
| Rate for Payer: Aetna Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,219.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,592.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,788.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,667.18
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Centivo All Commercial |
$3,747.28
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Humana Medicare |
$3,747.28
|
| Rate for Payer: Lucent All Commercial |
$3,747.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,865.56
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,245.46
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
| Rate for Payer: United Healthcare Medicare |
$2,424.71
|
|
|
HC W PLATE MTP L
|
Facility
IP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.70 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,348.33
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
|
|
HC W PLATE MTP R
|
Facility
OP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,201.37
|
| Rate for Payer: Aetna Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,424.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,219.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,592.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,788.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,667.18
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Centivo All Commercial |
$3,747.28
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Humana Medicare |
$3,747.28
|
| Rate for Payer: Lucent All Commercial |
$3,747.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,865.56
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,245.46
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
| Rate for Payer: United Healthcare Medicare |
$2,424.71
|
|
|
HC W PLATE MTP R
|
Facility
IP
|
$7,347.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.70 |
| Max. Negotiated Rate |
$6,833.27 |
| Rate for Payer: Aetna Commercial |
$6,348.33
|
| Rate for Payer: Cash Price |
$4,555.51
|
| Rate for Payer: Cigna All Commercial |
$6,340.98
|
| Rate for Payer: CORVEL All Commercial |
$6,833.27
|
| Rate for Payer: Coventry All Commercial |
$6,465.89
|
| Rate for Payer: Encore All Commercial |
$6,763.47
|
| Rate for Payer: Frontpath All Commercial |
$6,759.79
|
| Rate for Payer: Humana ChoiceCare |
$6,346.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,612.84
|
| Rate for Payer: PHCS All Commercial |
$5,510.70
|
| Rate for Payer: PHP All Commercial |
$5,572.42
|
| Rate for Payer: Sagamore Health Network All Products |
$5,672.35
|
| Rate for Payer: Signature Care EPO |
$6,098.51
|
| Rate for Payer: Signature Care PPO |
$6,465.89
|
| Rate for Payer: United Healthcare Commercial |
$5,789.91
|
|
|
HC W PLATE N/C FUSION LRG
|
Facility
IP
|
$6,854.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,140.80 |
| Max. Negotiated Rate |
$6,374.59 |
| Rate for Payer: Aetna Commercial |
$5,922.20
|
| Rate for Payer: Cash Price |
$4,249.73
|
| Rate for Payer: Cigna All Commercial |
$5,915.35
|
| Rate for Payer: CORVEL All Commercial |
$6,374.59
|
| Rate for Payer: Coventry All Commercial |
$6,031.87
|
| Rate for Payer: Encore All Commercial |
$6,309.48
|
| Rate for Payer: Frontpath All Commercial |
$6,306.05
|
| Rate for Payer: Humana ChoiceCare |
$5,920.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,168.96
|
| Rate for Payer: PHCS All Commercial |
$5,140.80
|
| Rate for Payer: PHP All Commercial |
$5,198.38
|
| Rate for Payer: Sagamore Health Network All Products |
$5,291.60
|
| Rate for Payer: Signature Care EPO |
$5,689.15
|
| Rate for Payer: Signature Care PPO |
$6,031.87
|
| Rate for Payer: United Healthcare Commercial |
$5,401.27
|
|
|
HC W PLATE N/C FUSION LRG
|
Facility
OP
|
$6,854.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,374.59 |
| Rate for Payer: Aetna Commercial |
$5,785.11
|
| Rate for Payer: Aetna Medicare |
$2,261.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,261.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,936.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,284.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,601.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,488.15
|
| Rate for Payer: Cash Price |
$4,249.73
|
| Rate for Payer: Cash Price |
$4,249.73
|
| Rate for Payer: Centivo All Commercial |
$3,495.74
|
| Rate for Payer: Cigna All Commercial |
$5,915.35
|
| Rate for Payer: CORVEL All Commercial |
$6,374.59
|
| Rate for Payer: Coventry All Commercial |
$6,031.87
|
| Rate for Payer: Encore All Commercial |
$6,309.48
|
| Rate for Payer: Frontpath All Commercial |
$6,306.05
|
| Rate for Payer: Humana ChoiceCare |
$5,920.15
|
| Rate for Payer: Humana Medicare |
$3,495.74
|
| Rate for Payer: Lucent All Commercial |
$3,495.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,168.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,140.80
|
| Rate for Payer: PHP All Commercial |
$5,198.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,673.22
|
| Rate for Payer: Sagamore Health Network All Products |
$5,291.60
|
| Rate for Payer: Signature Care EPO |
$5,689.15
|
| Rate for Payer: Signature Care PPO |
$6,031.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,826.24
|
| Rate for Payer: United Healthcare Commercial |
$5,401.27
|
| Rate for Payer: United Healthcare Medicare |
$2,261.95
|
|
|
HC W PLATE N/C FUSION SM
|
Facility
IP
|
$6,854.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,140.80 |
| Max. Negotiated Rate |
$6,374.59 |
| Rate for Payer: Aetna Commercial |
$5,922.20
|
| Rate for Payer: Cash Price |
$4,249.73
|
| Rate for Payer: Cigna All Commercial |
$5,915.35
|
| Rate for Payer: CORVEL All Commercial |
$6,374.59
|
| Rate for Payer: Coventry All Commercial |
$6,031.87
|
| Rate for Payer: Encore All Commercial |
$6,309.48
|
| Rate for Payer: Frontpath All Commercial |
$6,306.05
|
| Rate for Payer: Humana ChoiceCare |
$5,920.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,168.96
|
| Rate for Payer: PHCS All Commercial |
$5,140.80
|
| Rate for Payer: PHP All Commercial |
$5,198.38
|
| Rate for Payer: Sagamore Health Network All Products |
$5,291.60
|
| Rate for Payer: Signature Care EPO |
$5,689.15
|
| Rate for Payer: Signature Care PPO |
$6,031.87
|
| Rate for Payer: United Healthcare Commercial |
$5,401.27
|
|
|
HC W PLATE N/C FUSION SM
|
Facility
OP
|
$6,854.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,374.59 |
| Rate for Payer: Aetna Commercial |
$5,785.11
|
| Rate for Payer: Aetna Medicare |
$2,261.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,261.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,936.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,284.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,601.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,488.15
|
| Rate for Payer: Cash Price |
$4,249.73
|
| Rate for Payer: Cash Price |
$4,249.73
|
| Rate for Payer: Centivo All Commercial |
$3,495.74
|
| Rate for Payer: Cigna All Commercial |
$5,915.35
|
| Rate for Payer: CORVEL All Commercial |
$6,374.59
|
| Rate for Payer: Coventry All Commercial |
$6,031.87
|
| Rate for Payer: Encore All Commercial |
$6,309.48
|
| Rate for Payer: Frontpath All Commercial |
$6,306.05
|
| Rate for Payer: Humana ChoiceCare |
$5,920.15
|
| Rate for Payer: Humana Medicare |
$3,495.74
|
| Rate for Payer: Lucent All Commercial |
$3,495.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,168.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,140.80
|
| Rate for Payer: PHP All Commercial |
$5,198.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,673.22
|
| Rate for Payer: Sagamore Health Network All Products |
$5,291.60
|
| Rate for Payer: Signature Care EPO |
$5,689.15
|
| Rate for Payer: Signature Care PPO |
$6,031.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,826.24
|
| Rate for Payer: United Healthcare Commercial |
$5,401.27
|
| Rate for Payer: United Healthcare Medicare |
$2,261.95
|
|
|
HC W PLATE OFFSET SYDESMOSIS
|
Facility
OP
|
$2,365.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,199.45 |
| Rate for Payer: Aetna Commercial |
$1,996.06
|
| Rate for Payer: Aetna Medicare |
$780.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$780.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,358.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,478.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$897.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$858.50
|
| Rate for Payer: Cash Price |
$1,466.30
|
| Rate for Payer: Cash Price |
$1,466.30
|
| Rate for Payer: Centivo All Commercial |
$1,206.15
|
| Rate for Payer: Cigna All Commercial |
$2,041.00
|
| Rate for Payer: CORVEL All Commercial |
$2,199.45
|
| Rate for Payer: Coventry All Commercial |
$2,081.20
|
| Rate for Payer: Encore All Commercial |
$2,176.98
|
| Rate for Payer: Frontpath All Commercial |
$2,175.80
|
| Rate for Payer: Humana ChoiceCare |
$2,042.65
|
| Rate for Payer: Humana Medicare |
$1,206.15
|
| Rate for Payer: Lucent All Commercial |
$1,206.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,128.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,773.75
|
| Rate for Payer: PHP All Commercial |
$1,793.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$922.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1,825.78
|
| Rate for Payer: Signature Care EPO |
$1,962.95
|
| Rate for Payer: Signature Care PPO |
$2,081.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,010.25
|
| Rate for Payer: United Healthcare Commercial |
$1,863.62
|
| Rate for Payer: United Healthcare Medicare |
$780.45
|
|
|
HC W PLATE OFFSET SYDESMOSIS
|
Facility
IP
|
$2,365.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.75 |
| Max. Negotiated Rate |
$2,199.45 |
| Rate for Payer: Aetna Commercial |
$2,043.36
|
| Rate for Payer: Cash Price |
$1,466.30
|
| Rate for Payer: Cigna All Commercial |
$2,041.00
|
| Rate for Payer: CORVEL All Commercial |
$2,199.45
|
| Rate for Payer: Coventry All Commercial |
$2,081.20
|
| Rate for Payer: Encore All Commercial |
$2,176.98
|
| Rate for Payer: Frontpath All Commercial |
$2,175.80
|
| Rate for Payer: Humana ChoiceCare |
$2,042.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,128.50
|
| Rate for Payer: PHCS All Commercial |
$1,773.75
|
| Rate for Payer: PHP All Commercial |
$1,793.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,825.78
|
| Rate for Payer: Signature Care EPO |
$1,962.95
|
| Rate for Payer: Signature Care PPO |
$2,081.20
|
| Rate for Payer: United Healthcare Commercial |
$1,863.62
|
|
|
HC W PLATE POST FIB LRG L
|
Facility
OP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604996
|
|
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 POST FIB LRG L
|
Facility
IP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604996
|
|
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 POST FIB LRG R
|
Facility
OP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604997
|
|
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 POST FIB LRG R
|
Facility
IP
|
$5,450.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604997
|
|
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
|
|
