|
HC Z NAIL CPM 11.5MM X 36CM 130 R
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 36CM 130 R
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 38CM 125 L
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 38CM 125 L
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 38CM 125 R
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 38CM 125 R
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 38CM 130 L
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 38CM 130 L
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 38CM 130 R
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 38CM 130 R
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 40CM 125 L
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 40CM 125 L
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 40CM 125 R
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 40CM 125 R
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 40CM 130 L
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 40CM 130 L
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 40CM 130 R
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 40CM 130 R
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 42CM 125 L
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 42CM 125 L
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 42CM 125 R
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 42CM 125 R
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 42CM 130 L
|
Facility
IP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.38 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,688.95
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
|
|
HC Z NAIL CPM 11.5MM X 42CM 130 L
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
|
HC Z NAIL CPM 11.5MM X 42CM 130 R
|
Facility
OP
|
$7,741.84
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,199.91 |
| Rate for Payer: Aetna Commercial |
$6,534.11
|
| Rate for Payer: Aetna Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,554.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,446.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,839.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,938.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,810.29
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Cash Price |
$4,799.94
|
| Rate for Payer: Centivo All Commercial |
$3,948.34
|
| Rate for Payer: Cigna All Commercial |
$6,681.21
|
| Rate for Payer: CORVEL All Commercial |
$7,199.91
|
| Rate for Payer: Coventry All Commercial |
$6,812.82
|
| Rate for Payer: Encore All Commercial |
$7,126.36
|
| Rate for Payer: Frontpath All Commercial |
$7,122.49
|
| Rate for Payer: Humana ChoiceCare |
$6,686.63
|
| Rate for Payer: Humana Medicare |
$3,948.34
|
| Rate for Payer: Lucent All Commercial |
$3,948.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,967.66
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,806.38
|
| Rate for Payer: PHP All Commercial |
$5,871.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,019.32
|
| Rate for Payer: Sagamore Health Network All Products |
$5,976.70
|
| Rate for Payer: Signature Care EPO |
$6,425.73
|
| Rate for Payer: Signature Care PPO |
$6,812.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,580.56
|
| Rate for Payer: United Healthcare Commercial |
$6,100.57
|
| Rate for Payer: United Healthcare Medicare |
$2,554.81
|
|
