|
HC W PLATE REVISION MTP R
|
Facility
OP
|
$6,472.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,019.70 |
| Rate for Payer: Aetna Commercial |
$5,463.04
|
| Rate for Payer: Aetna Medicare |
$2,136.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,136.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,717.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,046.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,456.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,349.63
|
| Rate for Payer: Cash Price |
$4,013.14
|
| Rate for Payer: Cash Price |
$4,013.14
|
| Rate for Payer: Centivo All Commercial |
$3,301.13
|
| Rate for Payer: Cigna All Commercial |
$5,586.03
|
| Rate for Payer: CORVEL All Commercial |
$6,019.70
|
| Rate for Payer: Coventry All Commercial |
$5,696.06
|
| Rate for Payer: Encore All Commercial |
$5,958.21
|
| Rate for Payer: Frontpath All Commercial |
$5,954.98
|
| Rate for Payer: Humana ChoiceCare |
$5,590.56
|
| Rate for Payer: Humana Medicare |
$3,301.13
|
| Rate for Payer: Lucent All Commercial |
$3,301.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,825.52
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,854.60
|
| Rate for Payer: PHP All Commercial |
$4,908.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,524.39
|
| Rate for Payer: Sagamore Health Network All Products |
$4,997.00
|
| Rate for Payer: Signature Care EPO |
$5,372.42
|
| Rate for Payer: Signature Care PPO |
$5,696.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,501.88
|
| Rate for Payer: United Healthcare Commercial |
$5,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,136.02
|
|
|
HC W PLATE SHIFT FIX MDCO
|
Facility
OP
|
$5,774.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,370.19 |
| Rate for Payer: Aetna Commercial |
$4,873.59
|
| Rate for Payer: Aetna Medicare |
$1,905.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,905.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,316.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,609.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,191.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,096.11
|
| Rate for Payer: Cash Price |
$3,580.13
|
| Rate for Payer: Cash Price |
$3,580.13
|
| Rate for Payer: Centivo All Commercial |
$2,944.94
|
| Rate for Payer: Cigna All Commercial |
$4,983.31
|
| Rate for Payer: CORVEL All Commercial |
$5,370.19
|
| Rate for Payer: Coventry All Commercial |
$5,081.47
|
| Rate for Payer: Encore All Commercial |
$5,315.34
|
| Rate for Payer: Frontpath All Commercial |
$5,312.45
|
| Rate for Payer: Humana ChoiceCare |
$4,987.35
|
| Rate for Payer: Humana Medicare |
$2,944.94
|
| Rate for Payer: Lucent All Commercial |
$2,944.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,196.96
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,330.80
|
| Rate for Payer: PHP All Commercial |
$4,379.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,252.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,457.84
|
| Rate for Payer: Signature Care EPO |
$4,792.75
|
| Rate for Payer: Signature Care PPO |
$5,081.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,908.24
|
| Rate for Payer: United Healthcare Commercial |
$4,550.23
|
| Rate for Payer: United Healthcare Medicare |
$1,905.55
|
|
|
HC W PLATE SHIFT FIX MDCO
|
Facility
IP
|
$5,774.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,330.80 |
| Max. Negotiated Rate |
$5,370.19 |
| Rate for Payer: Aetna Commercial |
$4,989.08
|
| Rate for Payer: Cash Price |
$3,580.13
|
| Rate for Payer: Cigna All Commercial |
$4,983.31
|
| Rate for Payer: CORVEL All Commercial |
$5,370.19
|
| Rate for Payer: Coventry All Commercial |
$5,081.47
|
| Rate for Payer: Encore All Commercial |
$5,315.34
|
| Rate for Payer: Frontpath All Commercial |
$5,312.45
|
| Rate for Payer: Humana ChoiceCare |
$4,987.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,196.96
|
| Rate for Payer: PHCS All Commercial |
$4,330.80
|
| Rate for Payer: PHP All Commercial |
$4,379.30
|
| Rate for Payer: Sagamore Health Network All Products |
$4,457.84
|
| Rate for Payer: Signature Care EPO |
$4,792.75
|
| Rate for Payer: Signature Care PPO |
$5,081.47
|
| Rate for Payer: United Healthcare Commercial |
$4,550.23
|
|
|
HC W PLATE SM MD COLUMN FUSION
|
Facility
IP
|
$7,218.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604667
|
|
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
|
|
|
HC W PLATE SM MD COLUMN FUSION
|
Facility
OP
|
$7,218.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604667
|
|
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 SYNDESMOSIS
|
Facility
OP
|
$2,100.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,953.00 |
| Rate for Payer: Aetna Commercial |
$1,772.40
|
| Rate for Payer: Aetna Medicare |
$693.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$693.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,206.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,312.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$796.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$762.30
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Centivo All Commercial |
$1,071.00
|
| Rate for Payer: Cigna All Commercial |
$1,812.30
|
| Rate for Payer: CORVEL All Commercial |
$1,953.00
|
| Rate for Payer: Coventry All Commercial |
$1,848.00
|
| Rate for Payer: Encore All Commercial |
$1,933.05
|
| Rate for Payer: Frontpath All Commercial |
$1,932.00
|
| Rate for Payer: Humana ChoiceCare |
$1,813.77
|
| Rate for Payer: Humana Medicare |
$1,071.00
|
| Rate for Payer: Lucent All Commercial |
$1,071.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,890.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,575.00
|
| Rate for Payer: PHP All Commercial |
$1,592.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$819.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,621.20
|
| Rate for Payer: Signature Care EPO |
$1,743.00
|
| Rate for Payer: Signature Care PPO |
$1,848.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,785.00
|
| Rate for Payer: United Healthcare Commercial |
$1,654.80
|
| Rate for Payer: United Healthcare Medicare |
$693.00
|
|
|
HC W PLATE SYNDESMOSIS
|
Facility
IP
|
$2,100.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$1,953.00 |
| Rate for Payer: Aetna Commercial |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cigna All Commercial |
$1,812.30
|
| Rate for Payer: CORVEL All Commercial |
$1,953.00
|
| Rate for Payer: Coventry All Commercial |
$1,848.00
|
| Rate for Payer: Encore All Commercial |
$1,933.05
|
| Rate for Payer: Frontpath All Commercial |
$1,932.00
|
| Rate for Payer: Humana ChoiceCare |
$1,813.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,890.00
|
| Rate for Payer: PHCS All Commercial |
$1,575.00
|
| Rate for Payer: PHP All Commercial |
$1,592.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,621.20
|
| Rate for Payer: Signature Care EPO |
$1,743.00
|
| Rate for Payer: Signature Care PPO |
$1,848.00
|
| Rate for Payer: United Healthcare Commercial |
$1,654.80
|
|
|
HC W PLATE SYNDESMOSIS 4010
|
Facility
OP
|
$2,035.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,892.55 |
| Rate for Payer: Aetna Commercial |
$1,717.54
|
| Rate for Payer: Aetna Medicare |
$671.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$671.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,168.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,272.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$772.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$738.70
|
| Rate for Payer: Cash Price |
$1,261.70
|
| Rate for Payer: Cash Price |
$1,261.70
|
| Rate for Payer: Centivo All Commercial |
$1,037.85
|
| Rate for Payer: Cigna All Commercial |
$1,756.20
|
| Rate for Payer: CORVEL All Commercial |
$1,892.55
|
| Rate for Payer: Coventry All Commercial |
$1,790.80
|
| Rate for Payer: Encore All Commercial |
$1,873.22
|
| Rate for Payer: Frontpath All Commercial |
$1,872.20
|
| Rate for Payer: Humana ChoiceCare |
$1,757.63
|
| Rate for Payer: Humana Medicare |
$1,037.85
|
| Rate for Payer: Lucent All Commercial |
$1,037.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,831.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,526.25
|
| Rate for Payer: PHP All Commercial |
$1,543.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$793.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,571.02
|
| Rate for Payer: Signature Care EPO |
$1,689.05
|
| Rate for Payer: Signature Care PPO |
$1,790.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,729.75
|
| Rate for Payer: United Healthcare Commercial |
$1,603.58
|
| Rate for Payer: United Healthcare Medicare |
$671.55
|
|
|
HC W PLATE SYNDESMOSIS 4010
|
Facility
IP
|
$2,035.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,526.25 |
| Max. Negotiated Rate |
$1,892.55 |
| Rate for Payer: Aetna Commercial |
$1,758.24
|
| Rate for Payer: Cash Price |
$1,261.70
|
| Rate for Payer: Cigna All Commercial |
$1,756.20
|
| Rate for Payer: CORVEL All Commercial |
$1,892.55
|
| Rate for Payer: Coventry All Commercial |
$1,790.80
|
| Rate for Payer: Encore All Commercial |
$1,873.22
|
| Rate for Payer: Frontpath All Commercial |
$1,872.20
|
| Rate for Payer: Humana ChoiceCare |
$1,757.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,831.50
|
| Rate for Payer: PHCS All Commercial |
$1,526.25
|
| Rate for Payer: PHP All Commercial |
$1,543.34
|
| Rate for Payer: Sagamore Health Network All Products |
$1,571.02
|
| Rate for Payer: Signature Care EPO |
$1,689.05
|
| Rate for Payer: Signature Care PPO |
$1,790.80
|
| Rate for Payer: United Healthcare Commercial |
$1,603.58
|
|
|
HC W PLATE TACK CLAW II
|
Facility
OP
|
$805.00
|
|
| Hospital Charge Code |
41604346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$748.65 |
| Rate for Payer: Aetna Commercial |
$679.42
|
| Rate for Payer: Aetna Medicare |
$265.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$265.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$462.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$503.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$305.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$292.22
|
| Rate for Payer: Cash Price |
$499.10
|
| Rate for Payer: Cash Price |
$499.10
|
| Rate for Payer: Centivo All Commercial |
$410.55
|
| Rate for Payer: Cigna All Commercial |
$694.72
|
| Rate for Payer: CORVEL All Commercial |
$748.65
|
| Rate for Payer: Coventry All Commercial |
$708.40
|
| Rate for Payer: Encore All Commercial |
$741.00
|
| Rate for Payer: Frontpath All Commercial |
$740.60
|
| Rate for Payer: Humana ChoiceCare |
$695.28
|
| Rate for Payer: Humana Medicare |
$410.55
|
| Rate for Payer: Lucent All Commercial |
$410.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$724.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$603.75
|
| Rate for Payer: PHP All Commercial |
$610.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$313.95
|
| Rate for Payer: Sagamore Health Network All Products |
$621.46
|
| Rate for Payer: Signature Care EPO |
$668.15
|
| Rate for Payer: Signature Care PPO |
$708.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$684.25
|
| Rate for Payer: United Healthcare Commercial |
$634.34
|
| Rate for Payer: United Healthcare Medicare |
$265.65
|
|
|
HC W PLATE TACK CLAW II
|
Facility
IP
|
$805.00
|
|
| Hospital Charge Code |
41604346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$603.75 |
| Max. Negotiated Rate |
$748.65 |
| Rate for Payer: Aetna Commercial |
$695.52
|
| Rate for Payer: Cash Price |
$499.10
|
| Rate for Payer: Cigna All Commercial |
$694.72
|
| Rate for Payer: CORVEL All Commercial |
$748.65
|
| Rate for Payer: Coventry All Commercial |
$708.40
|
| Rate for Payer: Encore All Commercial |
$741.00
|
| Rate for Payer: Frontpath All Commercial |
$740.60
|
| Rate for Payer: Humana ChoiceCare |
$695.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$724.50
|
| Rate for Payer: PHCS All Commercial |
$603.75
|
| Rate for Payer: PHP All Commercial |
$610.51
|
| Rate for Payer: Sagamore Health Network All Products |
$621.46
|
| Rate for Payer: Signature Care EPO |
$668.15
|
| Rate for Payer: Signature Care PPO |
$708.40
|
| Rate for Payer: United Healthcare Commercial |
$634.34
|
|
|
HC W PLATE TIB DELTA LRG
|
Facility
OP
|
$4,748.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,416.01 |
| Rate for Payer: Aetna Commercial |
$4,007.65
|
| Rate for Payer: Aetna Medicare |
$1,566.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,566.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,727.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,968.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,802.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,723.67
|
| Rate for Payer: Cash Price |
$2,944.01
|
| Rate for Payer: Cash Price |
$2,944.01
|
| Rate for Payer: Centivo All Commercial |
$2,421.68
|
| Rate for Payer: Cigna All Commercial |
$4,097.87
|
| Rate for Payer: CORVEL All Commercial |
$4,416.01
|
| Rate for Payer: Coventry All Commercial |
$4,178.59
|
| Rate for Payer: Encore All Commercial |
$4,370.90
|
| Rate for Payer: Frontpath All Commercial |
$4,368.53
|
| Rate for Payer: Humana ChoiceCare |
$4,101.19
|
| Rate for Payer: Humana Medicare |
$2,421.68
|
| Rate for Payer: Lucent All Commercial |
$2,421.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,273.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,561.30
|
| Rate for Payer: PHP All Commercial |
$3,601.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,851.88
|
| Rate for Payer: Sagamore Health Network All Products |
$3,665.76
|
| Rate for Payer: Signature Care EPO |
$3,941.17
|
| Rate for Payer: Signature Care PPO |
$4,178.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,036.14
|
| Rate for Payer: United Healthcare Commercial |
$3,741.74
|
| Rate for Payer: United Healthcare Medicare |
$1,566.97
|
|
|
HC W PLATE TIB DELTA LRG
|
Facility
IP
|
$4,748.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,561.30 |
| Max. Negotiated Rate |
$4,416.01 |
| Rate for Payer: Aetna Commercial |
$4,102.62
|
| Rate for Payer: Cash Price |
$2,944.01
|
| Rate for Payer: Cigna All Commercial |
$4,097.87
|
| Rate for Payer: CORVEL All Commercial |
$4,416.01
|
| Rate for Payer: Coventry All Commercial |
$4,178.59
|
| Rate for Payer: Encore All Commercial |
$4,370.90
|
| Rate for Payer: Frontpath All Commercial |
$4,368.53
|
| Rate for Payer: Humana ChoiceCare |
$4,101.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,273.56
|
| Rate for Payer: PHCS All Commercial |
$3,561.30
|
| Rate for Payer: PHP All Commercial |
$3,601.19
|
| Rate for Payer: Sagamore Health Network All Products |
$3,665.76
|
| Rate for Payer: Signature Care EPO |
$3,941.17
|
| Rate for Payer: Signature Care PPO |
$4,178.59
|
| Rate for Payer: United Healthcare Commercial |
$3,741.74
|
|
|
HC W PLATE TIB DELTA SM
|
Facility
OP
|
$4,748.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,416.01 |
| Rate for Payer: Aetna Commercial |
$4,007.65
|
| Rate for Payer: Aetna Medicare |
$1,566.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,566.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,727.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,968.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,802.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,723.67
|
| Rate for Payer: Cash Price |
$2,944.01
|
| Rate for Payer: Cash Price |
$2,944.01
|
| Rate for Payer: Centivo All Commercial |
$2,421.68
|
| Rate for Payer: Cigna All Commercial |
$4,097.87
|
| Rate for Payer: CORVEL All Commercial |
$4,416.01
|
| Rate for Payer: Coventry All Commercial |
$4,178.59
|
| Rate for Payer: Encore All Commercial |
$4,370.90
|
| Rate for Payer: Frontpath All Commercial |
$4,368.53
|
| Rate for Payer: Humana ChoiceCare |
$4,101.19
|
| Rate for Payer: Humana Medicare |
$2,421.68
|
| Rate for Payer: Lucent All Commercial |
$2,421.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,273.56
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,561.30
|
| Rate for Payer: PHP All Commercial |
$3,601.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,851.88
|
| Rate for Payer: Sagamore Health Network All Products |
$3,665.76
|
| Rate for Payer: Signature Care EPO |
$3,941.17
|
| Rate for Payer: Signature Care PPO |
$4,178.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,036.14
|
| Rate for Payer: United Healthcare Commercial |
$3,741.74
|
| Rate for Payer: United Healthcare Medicare |
$1,566.97
|
|
|
HC W PLATE TIB DELTA SM
|
Facility
IP
|
$4,748.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,561.30 |
| Max. Negotiated Rate |
$4,416.01 |
| Rate for Payer: Aetna Commercial |
$4,102.62
|
| Rate for Payer: Cash Price |
$2,944.01
|
| Rate for Payer: Cigna All Commercial |
$4,097.87
|
| Rate for Payer: CORVEL All Commercial |
$4,416.01
|
| Rate for Payer: Coventry All Commercial |
$4,178.59
|
| Rate for Payer: Encore All Commercial |
$4,370.90
|
| Rate for Payer: Frontpath All Commercial |
$4,368.53
|
| Rate for Payer: Humana ChoiceCare |
$4,101.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,273.56
|
| Rate for Payer: PHCS All Commercial |
$3,561.30
|
| Rate for Payer: PHP All Commercial |
$3,601.19
|
| Rate for Payer: Sagamore Health Network All Products |
$3,665.76
|
| Rate for Payer: Signature Care EPO |
$3,941.17
|
| Rate for Payer: Signature Care PPO |
$4,178.59
|
| Rate for Payer: United Healthcare Commercial |
$3,741.74
|
|
|
HC W PLATE TIB MED L
|
Facility
IP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604979
|
|
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 TIB MED L
|
Facility
OP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604979
|
|
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 TIB MED R
|
Facility
OP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604978
|
|
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 TIB MED R
|
Facility
IP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604978
|
|
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 TIB SM L
|
Facility
OP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604977
|
|
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 TIB SM L
|
Facility
IP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604977
|
|
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 TIB SM R
|
Facility
OP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604976
|
|
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 TIB SM R
|
Facility
IP
|
$7,146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604976
|
|
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 TRANS-MET LAP L
|
Facility
OP
|
$7,120.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,622.34 |
| Rate for Payer: Aetna Commercial |
$6,009.96
|
| Rate for Payer: Aetna Medicare |
$2,349.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,349.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,089.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,451.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,702.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,584.85
|
| Rate for Payer: Cash Price |
$4,414.90
|
| Rate for Payer: Cash Price |
$4,414.90
|
| Rate for Payer: Centivo All Commercial |
$3,631.61
|
| Rate for Payer: Cigna All Commercial |
$6,145.25
|
| Rate for Payer: CORVEL All Commercial |
$6,622.34
|
| Rate for Payer: Coventry All Commercial |
$6,266.30
|
| Rate for Payer: Encore All Commercial |
$6,554.70
|
| Rate for Payer: Frontpath All Commercial |
$6,551.14
|
| Rate for Payer: Humana ChoiceCare |
$6,150.23
|
| Rate for Payer: Humana Medicare |
$3,631.61
|
| Rate for Payer: Lucent All Commercial |
$3,631.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,408.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,340.60
|
| Rate for Payer: PHP All Commercial |
$5,400.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,777.11
|
| Rate for Payer: Sagamore Health Network All Products |
$5,497.26
|
| Rate for Payer: Signature Care EPO |
$5,910.26
|
| Rate for Payer: Signature Care PPO |
$6,266.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,052.68
|
| Rate for Payer: United Healthcare Commercial |
$5,611.19
|
| Rate for Payer: United Healthcare Medicare |
$2,349.86
|
|
|
HC W PLATE TRANS-MET LAP L
|
Facility
IP
|
$7,120.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,340.60 |
| Max. Negotiated Rate |
$6,622.34 |
| Rate for Payer: Aetna Commercial |
$6,152.37
|
| Rate for Payer: Cash Price |
$4,414.90
|
| Rate for Payer: Cigna All Commercial |
$6,145.25
|
| Rate for Payer: CORVEL All Commercial |
$6,622.34
|
| Rate for Payer: Coventry All Commercial |
$6,266.30
|
| Rate for Payer: Encore All Commercial |
$6,554.70
|
| Rate for Payer: Frontpath All Commercial |
$6,551.14
|
| Rate for Payer: Humana ChoiceCare |
$6,150.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,408.72
|
| Rate for Payer: PHCS All Commercial |
$5,340.60
|
| Rate for Payer: PHP All Commercial |
$5,400.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,497.26
|
| Rate for Payer: Signature Care EPO |
$5,910.26
|
| Rate for Payer: Signature Care PPO |
$6,266.30
|
| Rate for Payer: United Healthcare Commercial |
$5,611.19
|
|
