|
HC Z PEG 1.8X10 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X12 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X12 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X14 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X14 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X16 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X16 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X18 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X18 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X20 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X20 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X22 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X22 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X24 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X24 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X26 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X26 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X28 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X28 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 1.8X30 LOCK
|
Facility
OP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.57 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$472.05
|
| Rate for Payer: Aetna Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.03
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Centivo All Commercial |
$285.24
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Humana Medicare |
$285.24
|
| Rate for Payer: Lucent All Commercial |
$285.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.13
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.40
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
| Rate for Payer: United Healthcare Medicare |
$184.57
|
|
|
HC Z PEG 1.8X30 LOCK
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.48 |
| Max. Negotiated Rate |
$520.15 |
| Rate for Payer: Aetna Commercial |
$483.24
|
| Rate for Payer: Cash Price |
$346.77
|
| Rate for Payer: Cigna All Commercial |
$482.68
|
| Rate for Payer: CORVEL All Commercial |
$520.15
|
| Rate for Payer: Coventry All Commercial |
$492.18
|
| Rate for Payer: Encore All Commercial |
$514.84
|
| Rate for Payer: Frontpath All Commercial |
$514.56
|
| Rate for Payer: Humana ChoiceCare |
$483.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.37
|
| Rate for Payer: PHCS All Commercial |
$419.48
|
| Rate for Payer: PHP All Commercial |
$424.17
|
| Rate for Payer: Sagamore Health Network All Products |
$431.78
|
| Rate for Payer: Signature Care EPO |
$464.22
|
| Rate for Payer: Signature Care PPO |
$492.18
|
| Rate for Payer: United Healthcare Commercial |
$440.73
|
|
|
HC Z PEG 202X22 LOCK STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
|
HC Z PEG 202X22 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PEG 202X24 LOCK STE
|
Facility
IP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.13 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$568.09
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
|
|
HC Z PEG 202X24 LOCK STE
|
Facility
OP
|
$657.51
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Aetna Commercial |
$554.94
|
| Rate for Payer: Aetna Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$249.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$238.68
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Cash Price |
$407.66
|
| Rate for Payer: Centivo All Commercial |
$335.33
|
| Rate for Payer: Cigna All Commercial |
$567.43
|
| Rate for Payer: CORVEL All Commercial |
$611.48
|
| Rate for Payer: Coventry All Commercial |
$578.61
|
| Rate for Payer: Encore All Commercial |
$605.24
|
| Rate for Payer: Frontpath All Commercial |
$604.91
|
| Rate for Payer: Humana ChoiceCare |
$567.89
|
| Rate for Payer: Humana Medicare |
$335.33
|
| Rate for Payer: Lucent All Commercial |
$335.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.76
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$493.13
|
| Rate for Payer: PHP All Commercial |
$498.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$256.43
|
| Rate for Payer: Sagamore Health Network All Products |
$507.60
|
| Rate for Payer: Signature Care EPO |
$545.73
|
| Rate for Payer: Signature Care PPO |
$578.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.88
|
| Rate for Payer: United Healthcare Commercial |
$518.12
|
| Rate for Payer: United Healthcare Medicare |
$216.98
|
|
